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PubMed1990

Surgical and prosthetic restoration of binaural hearing in an 88-year-old man.

We report the restoration of binaural hearing in an 88-year-old man who was experiencing significant communication difficulties. His preoperative air conduction thresholds had revealed a pure-tone average of 55 dB for the left ear and 107 dB for the right, and he was dissatisfied with the benefits provided by his BICROS hearing aid arrangement that had been fitted to his left ear. The combined effects of surgery and a hearing aid offered a 70 to 80 dB improvement for his right ear and restored the communication advantages of binaural hearing.

Aged↗
PubMed2006

Exploratory tympanotomy revealing incus discontinuity and stapedial otosclerosis as a cause of conductive hearing loss.

OBJECTIVE: To describe a unilateral progressive conductive hearing loss caused by incus discontinuity (without erosion of the long process of the incus), and otosclerosis with fixation of the stapedial footplate. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, Head and Neck Surgery of the University of Rochester Medical Center, which is a regional tertiary referral center. PATIENT: A 54-year-old woman with multiple otologic complaints including tympanic membrane perforations, otalgia, tinnitus, and hearing loss. Audiography demonstrated 100% speech discrimination bilaterally and a significant conductive right-sided hearing loss. INTERVENTION: The patient underwent a stapedectomy, during which a discontinuity between the long process of the incus and the stapes with no bony erosion was identified. The stapedectomy was completed and an ossicular piston prosthesis was inserted to reestablish ossicular continuity with the tympanic membrane. MAIN OUTCOME MEASURE: Improved subjective hearing confirmed objectively by audiography. CONCLUSION: This is the third reported case of an unusual combination of otosclerosis and ossicular discontinuity, and the first such case report in a patient without head trauma. In addition, it adds a unique item to the differential diagnosis of the pathologic features implicated in an ear with a conductive deficit and normal tympanogram.

Ear, Middle↗
PubMed1981

Method of reconstruction or preservation of external auditory canal.

A brief summary of methods for reconstruction of the external auditory meatus for whatever reason, which have been recommended and used by a number of authors, is presented. Recurrence of the atretic problem occurs in a great percentage of individuals necessitating further attempts with an even greater failure rate. In 13 ases with this problem, including congenital agenesis and/or atresia of the external auditory canal, exostectomies, and postsurgical stenosis, I have fund that surgery with concomitant use of Merocel wicks has given a "cure rate" of better than 90%. The first patient in this group has been followed for approximately two years.

Child↗
PubMed1986

[Functional results following stapedectomy. A 5-year study].

Results of partial stapedectomy with the formation of small fenestra and the use of teflon piston prostheses in the period of 1980-1984 are shown. Particular attention was paid to the group of patients under 18 years of age representing 3.3% of all operated cases, as well as to patients with combined hearing loss. In both groups, functional results of surgery were very good. Of the total of 284 operated ears, there were 20 reoperations.

Adolescent↗
PubMed1990

[Early complications following stapedectomy--surgical or conservative treatment?].

The incidence of sensorineural hearing loss after stapedectomy ranges from 0.6% to 5%. There is evidence that reparative granuloma is a major cause: most authors report that it requires urgent surgery, but this view is not universally accepted. This study analyses 14 stapedectomies that resulted in a sudden or gradual sensorineural hearing loss, often combined with vertigo, and presenting between 1 and 6 weeks after an initial hearing improvement. All patients were treated immediately with a combined infusion of an antibiotic, a corticosteroid and a plasma expander. The sensorineural hearing loss began to improve compared with pre-operative values 9 days later. Thus drug therapy might be sufficient in most cases of sensorineural hearing loss early after stapedectomy, and surgery can be restricted to patients with perilymph fistulae.

Adult↗
PubMed1983

Revision of previous stapedectomy, tympanoplasty, mastoidectomy, or endolymphatic shunt.

I have reviewed a group of otologic patients who represent controversial problems in management. Decisions for revisional otologic surgery must be based on each patient's individual findings. Statistical reviews are of little help in deciding which patient will benefit. Physicians managing patients with poor results after surgery for hearing, infection, or vertigo must obtain accurate audiologic, electronystagmographic, and laboratory data before deciding on revisional surgery. The overall interests of the patient are sometimes best served by avoiding further surgical insults to the ear.

Adolescent↗
PubMed1996

Osteogenesis imperfecta and hearing loss.

A review of the literature of osteogenesis imperfecta (OI) and hearing loss in the last century is given. This includes the first association in 1912 by Adair-Dighton of OI with hearing loss, the triad of VAN DER HOEVE and DE KLEYN and different clinical and audiometric studies and classifications of the disease. A case report of a 14 year old patient is also included. The genetics of OI and the complexity in correlating genetics with clinical classifications is elucidated. Finally, the findings reported after middle ear surgery, the results of surgery and comparisons with otosclerosis are reviewed.

Adolescent↗
PubMed1992

[Intraoperative monitoring with transtympanic electrocochleography].

Transtympanic electrocochleography (ECoG) enables auditory evoked potentials to be recorded directly from the peripheral organ, and ECoG recordings can be used as a routine during operations. Examples of cochlear and eighth nerve monitoring in middle ear, inner ear, and cerebellopontine angle surgery are given. This monitoring tool provides a continuous feedback to the surgeon of the effects of the operation on the cochlea and the auditory pathway.

Acoustic Stimulation↗
PubMed1981

The loose wire syndrome.

The loose wire syndrome occurs in patients who have had stapedectomy surgery and insertion of a prosthesis which attaches to the long process of the incus by means of a crimped wire. The syndrome consists of a triad of one or more symptoms which improve temporarily with middle ear inflation. These include improvements in auditory acuity, in distortion of sound, and in speech discrimination. Forty-three patients were studied for age, sex, and symptom distribution, and for results of corrective surgery. In all cases, a loose wire at its attachment to the incus was found and corrective surgery (tightening of the wire) was performed. Objectively and subjectively all but two patients were relieved of their symptoms.

Adult↗
PubMed1989

[Use of glass ionomer cement in surgery of the incus-stapedial joint. An initial report of experiences].

Chronic inflammations of the middle ear are characterised by perforation of the tympanic membrane as well as hearing loss, due to disintegration in the incudostapedial joint. Usually the perforation is easily restored by means of available modern procedures; on the other hand, failure of the reconstruction of the ossicular chain, especially of the incudostapedial joint, is not uncommon. Hence, the improvement of hearing capacity is transitory, since later, due to scars, graft lateralisation results in a dislocation of the primarily reconstructed ossicular chain. The patient's hearing capacity is then as poor as it has been before surgery. The aim of this study is to demonstrate the ways of satisfactory reconstruction of the incudostapedial joint by means of glass-ionomer cement: 1. Scar tissue connecting the ossicles in slight defects of the incudostapedial joint can be stabilised by glass-ionomer cement leading to a reasonable sound transmission. 2. If the incus has to be removed in case of a more serious defect, the columella can be properly fixed to the stapes by means of glass-ionomer cement without the risk of scar-induced lateralisation. 3. The fixation of the stapes prosthesis' wire loop to the incus can be effectively achieved by glass-ionomer cement.

Audiometry, Pure-Tone↗
PubMed1993

Posterior crus stapedectomy.

The results of stapedectomy were compared between 162 otosclerotic ears operated on using the posterior crus technique and 182 otosclerotic ears undergoing Teflon piston stapedectomy. The large fenestra technique with fascia seal to the oval window was used in all cases. Mean follow-up period was 9.6 years. Neither short-nor long-term hearing results showed any significant differences between the two surgical technique groups. Complications of surgery were more common in patients undergoing Teflon piston stapedectomy. On the other hand, a re-operation for recurring conductive deafness was performed significantly more often in patients undergoing posterior crus stapedectomy.

Adult↗
PubMed2001

[Practical considerations of surgical treatment of otosclerosis].

The ENT-specialist after determine the diagnosis, the deafness degree and the requirements of each otosclerotic individual must consider the therapeutic possibilities and the end results, also the complications, the indications and the contraindications. These considerations are fundamental under the forensic medicine viewpoint and a good medical practice and even in order to avoid failures provided preestablished prospectives and the outcomes fails to adhere to the proposed schedule. Surgical option is promising in cases of severe deafness when our aim is to improve the enlargement and recognition of environmental sounds when an acoustic prosthesis is not employed. In these cases possibly recruitment is present at the initial stages, which requires and adaptation period. Also must be analyzed the influence for surgery of environment factors and life-style (pressure changes, ambient noise, etc.), the existence of tinnitus, equilibrium disorders, hard of hearing features and the age. Results procured with surgery in unilateral otosclerosis are lesser compared with bilateral, which in association with the fact that in the majority od unilateral the degree of impairment (percent of binaural deficit) is minimal, compel us to be very cautions in counseling these patients.

Deafness↗
PubMed2001

[Ambulatory surgery of otosclerosis: retrospective study of 102 cases].

A retrospective study of 102 selected patients operated for otosclerosis (34 outpatient surgery, 68 hospitalised), having all of them the inclusion criteria of the ambulatory surgery, treated as outpatient in a traditional health sector or hospitalised, depending on their own choice, has been lead. We analysed the results of the pure tone audiometric tests two to six months after surgery. No significative difference was found between the two groups on audiometric results as for the postoperative complications. On the other side, it seems that young patients are more interested by the one-day surgery. The failure of the ambulatory surgery could be explained by the vertigo or dizziness per- or postoperatively. Finally, the evaluation of the cost-benefit shows that the ambulatory surgery in a traditional health sector could lead a budgetary saving policy. A saving way that will grow in a specialized sector devoted to the ambulatory practice.

Adult↗
PubMed1987

Stapedectomy in tympanosclerosis. A report of 67 cases.

Stapedectomy was performed in sixty-seven ears with tympanosclerotic footplate fixation. This was confined to the footplate in 90% of ears, and there was an association with cholesteatoma and chronic infection. Large fenestra stapedectomy was performed in 91% of cases and the surgical procedure performed was tympanoplasty in 91% of cases. Three cases (4.5%) suffered a dead ear by three years following the procedure, but only one immediately. A variety of surgical procedures were used to reconstruct the tympanic membrane to oval window connection, and the air-bone gap did not depend on the choice of prosthesis in the short term. Retention of the incus led to later increasing air-bone gap, probably due to refixation by tympanosclerosis. Long-term results are analyzed for each method of reconstruction and each category of ossicular status identified at surgery. Small fenestra procedures produced less cochlear hearing loss at high frequencies. Surgical technique is discussed with reference to the pathophysiology of tympanosclerosis, and the role of hearing aids is considered.

Adolescent↗
PubMed1997

Middle ear surgery under local anaesthesia and sedation.

BACKGROUND: Middle ear surgical procedures such as myringoplasty, stapedectomy and tympanolasty are traditionally performed under general anaesthesia, with induced hypotension. METHODS: We performed middle ear surgery in 73 patients, without induced hypotension, under local anaesthesia with sedation, and assessed feasibility, safety and acceptability. RESULTS: The operating conditions achieved were good and the complications were minor. None required conversion to general anaesthesia. CONCLUSION: Middle ear surgery under local anaesthesia and sedation is safe and feasible. Prospective trials are needed to fully assess the advantages of this technique over general anaesthesia.

Adolescent↗
PubMedDate not supplied

Surgery for congenital conductive deafness in Klippel-Feil syndrome.

A wide variety of anomalies of the middle and inner ear has been reported in association with congenital deafness in Klippel-Feil syndrome. Findings of six new exploratory tympanotomies are added to a review of 14 previously reported; for this entire group, better hearing was achieved in eight ears. When the only anomaly is a disconnection of the incudostapedial joint, good results can be expected from reconstruction of the ossicular chain. With the addition of the six newly reported stapedectomies, the success rate for this procedure now equals 50%. None of the fenestrations of the promontory performed for absence of the stapes and oval window have been successful. Since these results are encouraging, it is concluded that an exploratory tympanotomy should be considered during the course of hearing rehabilitation in cases of Klippel-Feil syndrome and a significant conductive hearing loss. Anomalies of inner ear structures established preoperatively may be a contraindication for stapedectomy.

Adult↗
PubMed1991

Tympano-ossicular allografts following J. Marquet: the evaluation of a school.

The experience with 1.645 transplantation procedures by ENT surgeons, trained in tympano-ossicular allograft technique following J. Marquet, is reported. The grafts originated from different tissue banks. The anatomical and functional results one year postoperatively were analysed. There appeared to be no statistical differences between tissue banks, nor between surgeons. Contrary to the anatomical results, functional differences existed between allograft tympanoplasties and some types of allograft tympano-ossiculoplasties. It was concluded that the routine use of allograft tympano-ossiculoplasty offers a major tool in otological surgery and that it is the method of choice by the ENT surgeons trained by the School of J. Marquet.

Belgium↗