Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults.

Surgical management of cholesteatoma limited to the attic and/or mesotympanum remains controversial. The aim of this study is to evaluate the anatomical and the functional results of trans-canal atticotomy in this pathological condition. The records of 27 adult patients treated from 2008 to 2014 who underwent trans-canal atticotomy for primary cholesteatoma surgery were reviewed. Pre-operative physical examination, audiometry, and CT-scan have been analyzed. Intraoperative findings have been described as well as the surgical technique. Anatomical and functional results have been evaluated with a mean follow-up of 24 ± 12.2 months, and the results of a CT-scan performed 1 year after surgery were examined to assess the presence of residual disease. Surgeries were uneventful. During the follow-up, 1 patient (4 %) experienced a retraction of the attical reconstruction; all the other patients had a well-healed tympanic drum with stable attical reconstruction. The mean air-bone gap was 19 ± 12.2 and 10 ± 7.3 dB pre-operatively and post-operatively, respectively (mean ± SD, p = 0.001, paired t test). Twenty-two patients (81 %) had no opacity suggesting residual cholesteatoma in CT-scan. Four patients (15 %) presenting an opacity at CT-scan underwent MRI study that was negative for residual cholesteatoma. One patient (4 %) had displacement of the ossicular prosthesis. In conclusion, cholesteatomas restricted to the attic and/or mesotympanum can be removed in a one-stage technique with no visible residual at 1 year, and with closure of the air-bone gap by 50 %.

Does the diameter of the stapes prosthesis really matter? A prospective clinical study.

OBJECTIVES/HYPOTHESIS: To evaluate the influence of the diameter of stapes prosthesis on functional outcomes in stapes surgery. STUDY DESIGN: Prospective cohort study. METHODS: Fifty consecutive small fenestra stapedotomies performed using a 0.4-mm-diameter prosthesis were compared with 50 consecutive small fenestra stapedotomies carried out using a 0.6-mm-diameter piston. Audiological assessment following the recommendations of the Committee on Hearing and Equilibrium was performed 1 month after surgery. Postoperative complications between the two groups were noted. RESULTS: There were no statistically significant differences in demographic data between the two groups, and no differences in preoperative bone-conduction (BC) or air-conduction (AC) hearing thresholds for all frequencies (analysis of variance [ANOVA] and χ2 tests). No differences were found in the mean preoperative BC and AC pure-tone average and air-bone gap (ABG). In the postoperative evaluation, a statistically significant difference was found for the mean AC gain (20 ± 8.7 vs. 24 ± 11.5, P = .042, ANOVA) as well as for the postoperative AC threshold at 0.125 and 0.25 kHz and the postoperative BC threshold at 0.25 kHz (P < .01, ANOVA). A postoperative ABG ≤10 dB was obtained in 90% and 94% of patients in the 0.4-mm- and 0.6-mm-diameter piston groups, respectively (difference not significant, χ2 test). No postoperative dead ear and/or sensorineural hearing loss was noted in either group. CONCLUSIONS: The 0.6-mm piston allowed a statistically significant higher AC gain compared with the 0.4-mm diameter piston. A larger diameter piston may be preferable if there are no anatomical or technical reasons that would favor a smaller prosthesis. LEVEL OF EVIDENCE: 2b Laryngoscope, 1922-1926, 2018.

Early functional results using the nitibond prosthesis in stapes surgery.

CONCLUSION: The NiTiBOND® prosthesis allows early results to be obtained similar to those with a manually crimped prosthesis fitted by experienced surgeons, thus reducing the learning curve in this critical step of the procedure. OBJECTIVE: To analyze the 1-month results using the nitinol NiTiBOND® prosthesis in primary otosclerosis surgery and to compare the results with those obtained with fully fluoroplastic or fully titanium pistons. MATERIALS AND METHODS: Fifty consecutive cases operated on with the NiTiBOND® prosthesis (nitinol group) were compared with 50 cases operated on with a fully fluoroplastic piston (fluoroplastic group), and with 131 cases operated on with a fully titanium piston (first titanium group), and also with 50 cases operated on with the same titanium piston just before using the NiTiBOND® piston (last titanium group). Pure-tone and speech audiometry was performed 1 month after surgery for the nitinol group. Comparison was made between the early hearing results of the four groups. RESULTS: The mean air-bone gap closure for the nitinol group was 16 ± 1.0 dB (mean ± SEM, n = 50); an air-bone gap of <15 dB and <10 dB was obtained in 100% and 84% of cases, respectively. These hearing results were similar to the last titanium group and significantly better than those observed in the fluoroplastic and first titanium groups.