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1.
Rev Fac Cien Med Univ Nac Cordoba ; 77(2): 73-78, 2020 04 27.
Artigo em Espanhol | MEDLINE | ID: mdl-32558508

RESUMO

INTRODUCCION: La otosclerosis es un trastorno de remodelación ósea caracterizada por disminución de la movilidad del estribo, lo que se traduce en una pérdida auditiva y tinnitus. El tratamiento mas comúnmente utilizado y mas eficaz es la cirugía. El objetivo principal es una mejora significativa en la pérdida auditiva, pero la reducción del tinnitus es un beneficio adicional. OBJETIVOS: Determinar los cambios en la sensación del tinnitus después de la estapedectomía en pacientes con otosclerosis operados en nuestro medio; así también como los factores que podrían asociarse con dichos cambios. MATERIALES Y METODOS: Realizamos un estudio prospectivo, observacional, analítico y longitudinal, en el que se incluyeron 15 pacientes con otosclerosis operados en el Sanatorio que se sometieron a un examen completo con Audiometría, Acúfenometría y Tomografía computada; se recopilaron datos mediante la Escala de Impresión Clínica Global y el Indice Funcional del Tinnitus, al momento previo a la cirugía y a los tres meses de intervenidos. Se utilizó el Soft R- medic e Infostat para analizar las variables y graficar los resultados. RESULTADOS: Las diferencias entre el estado de audición pre y postoperatoria fueron estadisticamente significativas (p<<0.001). Se comprobó además, diferencias estadísticamente significativas entre la percepción del tinnitus antes y despues de la cirugía (p<<0.001). Y que dicha diferencia se relaciona estadíticamente con la mejoría de la audición (p=0.01). DISCUSION- CONCLUSION: La mayoría de los pacientes refirieron una mejoría en el estado de percepción del acúfeno; además de la mejoría en su audición; resultando en asociación significativa ambas variables.


Assuntos
Otosclerose/cirurgia , Cirurgia do Estribo , Zumbido/cirurgia , Adulto , Feminino , Hospitais Universitários , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Otosclerose/complicações , Estudos Prospectivos , Zumbido/etiologia , Resultado do Tratamento
2.
Orv Hetil ; 161(19): 780-788, 2020 05.
Artigo em Húngaro | MEDLINE | ID: mdl-32365050

RESUMO

Otosclerosis is a human-specific ear disease characterised by complex bone-remodelling with multifactorial aetiology. It affects the bony labyrinth capsule and consequently fixates the stapes to the oval window rim. The fixation of the ossicular chain leads to a decrease in the middle ear's acoustic impedance-fitting and amplifier function that leads to conductive hearing loss. The process is progressive and when it involves the inner ear structures, it deteriorates the sensorineural function as well. The course of the illness can be prevented or delayed if hearing reconstructive surgery is performed on time. The development of stapes surgery spans the 20th century, and despite the major surgical steps - laid down by Shea and Marquet in the 1960s - are quite conservative, fine adjustments are still being made mainly due to technical progress. Several studies confirm that stapedotomy remained the first-to-offer therapeutic option in otosclerosis. With an adequate surgical technique, significant improvement can be achieved in the air conduction threshold, the air-bone gap may be minimalized or ceased over the speech frequencies, which significantly improves the quality of life of the patients. In this quest, we reviewed the Hungarian and the international literature as well in context with otosclerosis, with special attention to the newest methods in diagnostics and treatment management. Orv Hetil. 2020; 161(19): 780-788.


Assuntos
Perda Auditiva/cirurgia , Prótese Ossicular , Otosclerose/cirurgia , Cirurgia do Estribo/métodos , Condução Óssea/fisiologia , Perda Auditiva/etiologia , Perda Auditiva Condutiva , Humanos , Otosclerose/complicações , Otosclerose/diagnóstico , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
3.
J Laryngol Otol ; 134(5): 398-403, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32308176

RESUMO

OBJECTIVES: To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery. METHODS: Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results. RESULTS: Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques. CONCLUSION: Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.


Assuntos
Endoscopia/métodos , Microcirurgia/métodos , Cirurgia do Estribo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Perda Auditiva/complicações , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Otosclerose/complicações , Otosclerose/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Adulto Jovem
4.
Otolaryngol Head Neck Surg ; 162(4): 544-547, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32093549

RESUMO

OBJECTIVE: The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy. STUDY DESIGN: Retrospective observational study of national health care claims. SETTING: 2003 to 2016 Optum Clinformatics Data Mart. SUBJECTS AND METHODS: In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery. RESULTS: The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; t test, P < .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; t test, P < .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; t test, P < .0001). A higher number of children was correlated with lower age for both females (Pearson, r = -0.3817, P < .0001) and males (Pearson, r = -0. 3675, P < .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children (F(3, 6021) = 336.93, P < .001, R2 = 0.1437) with no significant interaction between sex and number of children (P = .186). CONCLUSION: Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis.


Assuntos
Otosclerose/cirurgia , Paridade , Cirurgia do Estribo/estatística & dados numéricos , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores Sexuais
5.
Otolaryngol Head Neck Surg ; 162(4): 548-553, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31959042

RESUMO

OBJECTIVE: To compare surgical outcomes of transcanal endoscopic ear surgery (TEES) for congenital ossicular anomalies with those of conventional microscopic surgery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral academic center. SUBJECTS AND METHODS: From March 2012 to November 2018, 42 consecutive ears in 40 patients with congenital ossicular anomaly who underwent ossiculoplasty or stapes surgery using either ear endoscopes (TEES group) or an operating microscope (microscopic group) were included. Postoperative audiometric results, operation time, switch of approach, and complications were compared between the 2 groups. RESULTS: Twenty-four ears (66.1%) were in the microscopic group and 18 ears (33.9%) were in the TEES group. The mean (SD) preoperative air-bone gap was 31.8 (10.0) dB in the microscopic group and 35.2 (11.1) dB in the TEES group. The mean (SD) postoperative air-bone gap was 7.4 (6.5) dB in the microscopic group and 5.6 (5.0) dB in the TEES group. The differences in the preoperative and postoperative air-bone gaps between the 2 groups were not statistically significant (P = .316 and P = .412, respectively). Average operation time in the TEES group was 24.6 minutes shorter than that in the microscopic group, which was statistically significant (P = .019). None of patients in the TEES group did require a switch of approach. There was no significant difference in complication incidence between the 2 groups. CONCLUSIONS: TEES for congenital ossicular anomaly has comparable audiometric results and complication rates to conventional microscopic surgery. TEES appears to have the advantages of shorter operation times.


Assuntos
Ossículos da Orelha/anormalidades , Ossículos da Orelha/cirurgia , Endoscopia , Microcirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , Cirurgia do Estribo/métodos , Resultado do Tratamento
6.
Orv Hetil ; 160(51): 2007-2011, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31838860

RESUMO

Otosclerosis is a bone remodeling disorder affecting exclusively the human temporal bone which causes small bony lesions in the otic capsule. The symptoms depend on the location and the extent of the otosclerotic foci. Hence, clinically the most relevant sign is the conductive hearing loss due to the stapedial otosclerosis with fixation of the stapes footplate. In many cases, the specific anamnestic features, the age of presentation and usually the absence of tympanic membrane pathology can provide a strong clinical suspicion for otosclerosis. Although audiometric and imaging examinations and VEMP testing can confirm our preoperative diagnosis, the histolopathologic examination of the removed stapes footplate is the most accurate way to determine the diagnosis. Orv Hetil. 2019; 160(51): 2007-2011.


Assuntos
Perda Auditiva Condutiva/etiologia , Otosclerose/diagnóstico , Estribo/patologia , Audiometria , Humanos , Cirurgia do Estribo
7.
BMJ Case Rep ; 12(11)2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31690690

RESUMO

Pneumolabyrinth is the entrapment of air within the inner ear and is a rare complication of stapes surgery. We report the case of a patient submitted to stapedectomy who, 4 weeks later, suddenly developed right hearing loss, ipsilateral tinnitus and vertigo. On the physical examination, the patient showed no signs of vestibular deficits. Audiometry was compatible with right profound mixed hearing loss and high-resolution CT of the temporal bone revealed the presence of pneumolabyrinth. During exploratory tympanotomy, the prosthesis was found dislodged; the communication between the middle and inner ear was closed with vein graft and a new prosthesis was placed. Following surgery, vestibular symptoms was abolished and the patient experienced great improvement of the hearing thresholds.


Assuntos
Doenças do Labirinto/etiologia , Ventilação da Orelha Média , Osteosclerose/cirurgia , Cirurgia do Estribo/efeitos adversos , Esteroides/uso terapêutico , Audiometria de Tons Puros , Feminino , Perda Auditiva , Humanos , Doenças do Labirinto/diagnóstico , Pessoa de Meia-Idade , Zumbido , Resultado do Tratamento
8.
Otolaryngol Head Neck Surg ; 161(6): 1018-1026, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31570044

RESUMO

OBJECTIVE: The objective of this study was to provide a proof of concept and to assess the success and safety of stapes surgery for otosclerosis under local anesthesia in an office-based setting (OBS) as compared with a hospital operating room setting (ORS). STUDY DESIGN: Retrospective cohort study. SETTING: We reviewed all patients who underwent stapes surgery by the same surgeon from October 2014 to January 2017 at our tertiary care center (ORS, n = 36, 52%) and in an OBS (n = 33, 48%). SUBJECTS AND METHODS: The surgical technique was identical in both groups. All patients had a temporal bone computed tomography scan and audiogram within the 6 months prior to surgery. Air-bone gaps (ABGs), bone conduction, and air conduction pure tone average values were calculated. Preoperative results for pure tone average, bone conduction, ABG, and word recognition scores were compared with early (4 months) and late (12 months) follow-up audiograms. Intra- and postoperative complications were compared. RESULTS: Both groups were comparable in terms of demographic characteristics and severity of disease. The mean 1-year postoperative ABG was 5.66 dB (95% CI = 4.42-6.90) in the ORS group and 6.30 dB (95% CI = 4.50-8.10) in the OBS group (P = .55). ABG improved by 24.27 dB (95% CI = 21.40-27.13) in the ORS group and 23.15 dB (95% CI = 18.45-27.85) in the OBS group (P = .68). Complication rates did not differ, although this study remains underpowered. CONCLUSIONS: In this small group of patients, the success of stapes surgery performed in an OBS and its complications were comparable to those of an ORS, thus providing an alternative to patients on long operating room waiting lists.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Otosclerose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia do Estribo/efeitos adversos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudo de Prova de Conceito , Estudos Retrospectivos , Resultado do Tratamento
9.
PLoS One ; 14(9): e0222728, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536572

RESUMO

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer.


Assuntos
Cartilagem/transplante , Osso Temporal/cirurgia , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/cirurgia , Timpanoplastia/métodos , Estimulação Acústica , Humanos , Som , Cirurgia do Estribo/métodos , Osso Temporal/lesões , Osso Temporal/fisiopatologia , Membrana Timpânica/lesões , Membrana Timpânica/fisiopatologia , Perfuração da Membrana Timpânica/fisiopatologia , Vibração
10.
Vestn Otorinolaringol ; 84(3): 61-64, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31486430

RESUMO

A case of perilymphatic fistula with the luxation of the stapes into vestibule was described, which was caused by a direct damage of the eardrum (the patient cleaned the right ear with a cotton swab and received a strong blow to the arm). The moment of injury was characterized by severe pain, a significant hearing loss, the appearance of tympanophonia and vertigo. Clinical examination revealed the eardrum rupture. After perforation healing the hearing did not improve, a high degree of mixed sensorineural hearing loss remained with a bone-air interval of up to 50 dB throughout the tone scale. CT of the temporal bones showed a pneumolabirinth and a change in the malleus position, which made it possible to suggest the presence of a perilymphatic fistula with the luxation of the stapes. The extent of damage was confirmed by surgery. The stapes was removed and the perilymphatic fistula was closed.


Assuntos
Fístula , Cirurgia do Estribo , Doenças Vestibulares , Vestíbulo do Labirinto , Humanos , Estribo , Vertigem
11.
Eur Arch Otorhinolaryngol ; 276(11): 2975-2982, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31428864

RESUMO

OBJECTIVES: To compare quality-of-life (QoL) measurements with audiological results after stapes surgery with two different prostheses. METHODS: This is a retrospective longitudinal study. All patients required stapes surgery for otosclerosis and ossicular chain reconstruction with either a titanium band prothesis (TBP) or receiving a nitinol head prosthesis (NHP). Intervention was between January 2011 and March 2017 patients received stapes-surgery with either TBP (n = 95) or NHP (n = 50). Audiological measurements at three different time points (preoperatively, early follow up < 3 months, late follow-up > 3 months) were compared and two different QoL-inventories, the Glasgow-Benefit-Inventory (GBI) and the Stapes-Plasty-Outcome-Test-25 (SPOT-25) were investigated postoperatively. The main outcome measures were Pure tone average (PTA) at 0.5, 1, 2, 3 kHz at early and late follow up after stapes surgery were compared and correlated with the subjective benefit on the QoL inventories. The perforation method and the type of surgery were analyzed as potentially influencing factors. RESULTS: All patients showed a significantly reduced air bone gap (ABG 0.5, 1, 2, 3) at the two follow-up visits (visit 2: mean: 13.6 dB, SD 7.7; visit 3: mean: 12.7 dB SD 8.1) compared to preoperative measurements (mean: 28.9 dB, SD 9.9) and subjectively benefitted from stapes surgery (mean GBI score: 21.55; SD 20.60, mean SPOT-25 score: 28.03; SD 18.53). The outcome of the two questionnaires correlated with each other. Neither the hearing-outcome nor the subjective benefit was significantly influenced by the prosthesis, the perforation method or the type of anesthesia. CONCLUSIONS: Both prostheses were safe and led to comparable hearing results as well as to subjective benefits in the Health-related-Quality-of-Life (HrQoL). A combination of the two questionnaires is recommendable for postoperative quality control.


Assuntos
Indicadores Básicos de Saúde , Prótese Ossicular , Otosclerose/cirurgia , Qualidade de Vida , Cirurgia do Estribo/instrumentação , Adulto , Feminino , Seguimentos , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/diagnóstico , Estudos Retrospectivos , Cirurgia do Estribo/métodos , Resultado do Tratamento
12.
Int J Pediatr Otorhinolaryngol ; 126: 109601, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369970

RESUMO

OBJECTIVES: Perilymph gusher (PLG), an uncommon complication of otologic surgery, has been attributed to communication between the cochlea and the internal auditory canal (IAC). Subtle osseous defects may be missed on routine review of computed tomography (CT). This study aimed to quantify cochlear basal turn patency not seen on axial CT in patients with PLG and compare those against patients without intraoperative PLG. METHODS: Ears that underwent cochlear implantation or stapedotomy with preoperative helical CT that was interpreted as "normal" at a tertiary referral center. An otologist and a radiologist independently and in a blinded fashion measured the dimensions of cochlear basal turn patency on CT images in oblique plane and parasagittal planes along the interface of the cochlea and IAC fundus. RESULTS: Sixty-one ears were reviewed, including 3 with surgically confirmed PLGs and 12 with apparent dehiscence without a PLG. Mean defect width with PLG was 0.83 mm (range 0.75-0.9 mm) and without PLG was 0.43 mm (range 0.3-0.65 mm, p = 0.011). A greater proportion of PLGs occurred in ears with defects (3 of 15) than in ears without (0 of 46, p = 0.013). Using a cutoff of 0.75 mm, a greater proportion of PLGs occurred with defect width >0.75 mm (3 of 3) than in defects <0.75 mm (0 of 12, p = 0.022). CONCLUSIONS: CT dehiscence between the IAC and cochlear basal turn, particularly with a width > 0.75 mm, should be considered a risk for PLG with stapedotomy or cochlear implantation.


Assuntos
Implante Coclear , Orelha Interna/anormalidades , Complicações Intraoperatórias/etiologia , Perilinfa , Cirurgia do Estribo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cóclea/anormalidades , Cóclea/diagnóstico por imagem , Orelha Interna/diagnóstico por imagem , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Método Simples-Cego , Tomografia Computadorizada Espiral , Adulto Jovem
13.
Acta Otolaryngol ; 139(10): 843-848, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437058

RESUMO

Background: Stapedotomy has been proved to be one of the most efficient procedure to treat otosclerosis, various factors contribute to the diversity of the outcomes and controversial results exist from previous studies. Objectives: We evaluated clinical characteristics and outcomes of stapedotomy, as well as possible predictive factors of a successful outcome. Materials and methods: This retrospective study evaluated 58 ears from 48 patients with demographic data, plus short-term follow-up of hearing outcomes of 28 ears, and evaluated variables using univariate general linear regression analyses. Results: The average operation age was 41.54 years. A total of 87.5% (42/48) patients presented with bilateral otosclerosis. 39.66% (23/58) ears had CT finding before the surgery. Patients with persistent tinnitus accounted for 53.45% (31/58) and the average preoperative ABG of the 58 ears was 32.22 dB. We achieved good postoperative air-bone gaps (ABGs) overall but poor ABG closure at 4 kHz. No predictive factors were identified in the 28 ears that were followed up. Conclusions and significance: Delayed surgery may be attributable to insufficient recognition of otosclerosis. The fenestration size could be the reason for poor ABG closure at high frequency. However, more cases and longer follow-ups are required to confirm our findings.


Assuntos
Otosclerose/cirurgia , Cirurgia do Estribo , Adulto , Idoso , Limiar Auditivo , Feminino , Seguimentos , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Eur Arch Otorhinolaryngol ; 276(11): 3035-3041, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31392458

RESUMO

BACKGROUND: Although, both the microscopic and endoscopic stapes surgery have claimed a parallel audiological outcome, the comparison between two standard endoscopes (4 mm and 3 mm) in endoscopic stapedotomy is not well documented. We have compared the clinical utility and audiological outcomes of the 3 mm and 4 mm rigid nasal endoscopes in the primary endoscopic stapedotomy. MATERIALS AND METHODS: This is a retrospective study conducted in the Department of Otorhinolaryngology between June 2015 and May 2018. Total 46 patients of primary otosclerosis had undergone endoscopic stapedotomy where 3 mm and 4 mm nasal endoscopes have been used in 22 (group A) and 24 patients (group B) respectively. The preoperative, intraoperative and postoperative surgical findings including the hearing outcomes were compared between the two groups. RESULTS: One patient (4.5%) in group A and 6 (25%) patients in group B required canaloplasty (p = 0.00, χ2 test) and 7 (31.18%) patients in group A and 18(75%) in group B had required curettage of the bony canal wall (p = 0.04, χ2 test). There was no significant difference in the air-bone gap between the two groups (p = 0.85). CONCLUSION: Both 3 mm and 4 mm nasal endoscopes can be successfully used in the endoscopic stapedotomy providing a parallel visual field. Although, comparable results can be obtained in preserving the chorda tympani nerve, tympanic membrane, facial nerve, and postoperative giddiness including the audiological outcomes, the requirement of the canaloplasty and curettage of posterior bony canal can be significantly reduced in patients operated with 3 mm nasal endoscope, especially in patients with narrow/over angulated external auditory canal.


Assuntos
Endoscópios , Endoscopia/instrumentação , Otosclerose/cirurgia , Cirurgia do Estribo/instrumentação , Adulto , Endoscopia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia do Estribo/métodos , Resultado do Tratamento , Adulto Jovem
15.
ORL J Otorhinolaryngol Relat Spec ; 81(4): 224-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31315120

RESUMO

BACKGROUND: Stapes surgery is a common method of treatment of otosclerosis, and its effectiveness is reported based on audiometric hearing thresholds. Audiometric tests do not gauge the impact of tinnitus severity and auditory function on quality of life (QOL) after stapes surgery. OBJECTIVE: To measure self-assessed QOL in otosclerosis patients after stapedotomy in terms of three major factors: change in audiometric hearing threshold, subjective hearing benefit, and tinnitus severity. METHOD: This prospective clinical study included 191 patients who underwent stapedotomy between April and October 2017 due to otosclerosis. All patients were tested by pure tone audiometry and filled in a questionnaire before surgery and 6 months afterwards. Subjective hearing was assessed with the Abbreviated Profile for Hearing Aid Benefit (APHAB); tinnitus severity was established using the Tinnitus Functional Index (TFI), and the QOL was measured by the Glasgow Benefit Inventory (GBI). RESULTS: Statistical analysis showed that the average GBI total score (mean = 33.7; SD = 23.7) was statistically significantly higher than zero (t = 19.7; p < 0.001). Based on a regression model, all the three variables studied - audiometric hearing thresholds change, APHAB change, and TFI change - had a significant effect on QOL after stapedotomy. Interestingly, the highest beta value (b = 0.040; p < 0.001) was for TFI change, implying that TFI change had the greatest effect on QOL. CONCLUSION: Although the improvement of QOL after stapes surgery undoubtedly depended on improvement in both audiometric and self-reported hearing, the reduction of tinnitus severity had the greatest impact on increase in QOL.


Assuntos
Limiar Auditivo/fisiologia , Perda Auditiva Condutiva/cirurgia , Otosclerose/cirurgia , Qualidade de Vida , Cirurgia do Estribo , Zumbido/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Feminino , Seguimentos , Perda Auditiva Condutiva/complicações , Perda Auditiva Condutiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/complicações , Otosclerose/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Zumbido/complicações , Zumbido/fisiopatologia , Resultado do Tratamento , Adulto Jovem
16.
Artigo em Chinês | MEDLINE | ID: mdl-31327209

RESUMO

Objective:The aim of this study is to understand the imaging morphology of the humerus morphology and its associated simulated lesions, and to provide information for related research. Method:Six adult cadaveric heads fixed by formaldehyde solution (12 sides of the tibia) were used. One of the cadaveric heads (two sides of the tibia) was perforated and fractured under the microscope.The remaining 5 (10 sides) were used. The humerus was used for morphological measurements of the tibia.The tibia (12 sides) was taken out, Micro-CT scan was performed, and two-dimensional and three-dimensional reconstruction were performed using software such as Mimics 17.0 software. Result:①Stapedial morphologic observation:the head,curs and footplate of the stapes and the adjacent structures can be well displayed on two dimensional structures.②Quantitative measurements and statistics: There were no significant statistic differences about the data that had been measured between the right ears and the left ears.③Micro-CT was more clearly in displaying the precise structure of human stapes and the stapedial minute lesion comparing with that of HRCT. Conclusion:Micro-CT can accurately and clearly display the structure, morphology and simulated lesions (model) of the tibia, which provides important reference materials and methods for related research.


Assuntos
Estapédio/patologia , Cirurgia do Estribo , Estribo/diagnóstico por imagem , Adulto , Cadáver , Humanos , Microtomografia por Raio-X
17.
Eur Arch Otorhinolaryngol ; 276(9): 2363-2376, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273448

RESUMO

OBJECTIVE: The aim of this study is to perform a systematic literature review on the occurrence of gusher during stapes surgery, to understand its surgical management and outcomes. METHODS: The PRISMA standard was applied to identify English, Italian or French-language studies, related to stapes surgery and mentioning gusher or perilymphatic leak. Full-texts lacking information on the management of gusher and/or the post-operative hearing outcome were excluded. RESULTS: Twenty-four articles were eventually included. Seventy-six patients were involved in the qualitative synthesis. The management of gusher mostly consisted in covering the oval window and/or filling the tympanic cavity, with absorbable and autologous graft materials. Packing of the external auditory canal was reported in 51 patients (67%). Gusher was related to complete/profound loss of hearing in 25% of the cases and to a worsening of hearing function in 31% of patients. In 19% of patients an improvement in hearing tests was reported; in 28% the hearing function was unchanged. Post-operative vestibular symptoms were reported in 7 patients, and were mainly mild and transient. The absence of vestibular symptoms was underlined in 9 cases, while in 79% of the patients the authors did not provide information. CONCLUSION: The unexpected occurrence of gusher during stapes surgery represents a relevant issue for the otologic surgeon. Its management most commonly consists in plugging the oval window and the tympanic cavity. In most of the cases, a stapes prosthesis could be positioned. The results on hearing and vestibular functions are widely variable.


Assuntos
Vazamento de Líquido Cefalorraquidiano/terapia , Perilinfa , Cirurgia do Estribo/efeitos adversos , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/terapia , Masculino , Prótese Ossicular , Janela do Vestíbulo , Complicações Pós-Operatórias/terapia
18.
J Laryngol Otol ; 133(8): 658-661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31270001

RESUMO

OBJECTIVE: This study aimed to evaluate the long-term results of ossiculoplasty using bone cement. METHOD: Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9-54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air-bone gaps were calculated according to international guidelines. RESULTS: There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 dB), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 dB), and this result was significant (p < 0.0001). The pre-operative air-bone gap was 27.65 dB and decreased to 19.65 dB during follow-up (p = 0.0001). No adverse reactions or complications were observed. CONCLUSION: Bone cement is reliable for the repair of incudostapedial-joint defects.


Assuntos
Perda Auditiva Condutiva/cirurgia , Substituição Ossicular/instrumentação , Otite Média/cirurgia , Cirurgia do Estribo/instrumentação , Adolescente , Adulto , Audiometria , Cimentos para Ossos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Ann Otol Rhinol Laryngol ; 128(11): 1054-1060, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31288548

RESUMO

OBJECTIVES: To present a systematic checklist to improve diagnosing otosclerosis (OS) on high-resolution computed tomography (HRCT) of the temporal bones and review this protocol's efficacy in diagnosing OS on HRCT. METHODS: A retrospective case series was performed at a University Referral Hospital in urban Chicago, Illinois. High-resolution computed tomographies of the temporal bone were reviewed including 17 ears in the test group with surgically confirmed OS and 21 ears in the control group surgically confirmed to not have OS. Preoperative HRCTs were evaluated by a single neuroradiologist using a systematic protocol created to assist in diagnosing OS. This looked for radiolucency at the fissula ante fenestram and pericochlear region, and new bone formation around the oval and round windows. RESULTS: The radiologist accurately diagnosed OS in all 17 test group ears and ruled out OS in all 21 control group ears using the protocol. All 17 test ears were read to have lucency at the fissula ante fenestram, 9 (53.0%) to have new bone formation, and 8 (47.1%) to have cochlear lucency. The radiologist was more confident in diagnosing OS when cochlear lucency was present with the fissula ante fenestram lucency. CONCLUSIONS: This HRCT checklist is a highly accurate tool for evaluating the presence of OS when images are reviewed in the systematic fashion described. Imaging prior to surgery aids in counseling patients, preparing surgically, and excluding other pathologies.


Assuntos
Cóclea/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Otosclerose/diagnóstico , Osso Temporal/diagnóstico por imagem , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia do Estribo/métodos
20.
Acta Otolaryngol ; 139(10): 829-832, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31298596

RESUMO

Background: The insertion of the stapes piston within the vestibule provides the physical basis for a successful stapedotomy. An insertion depth of 0.5 mm is recommended to avoid the dislocation of the stapes prosthesis (e.g. sneezing). Aims: The objective of this study is to analyze the depth of stapes prosthesis insertion and its correlation with clinical outcome. Material and methods: We observed in a retrospective case series 39 otosclerosis patients after a stapedotomy and a postoperative performed flat panel tomography/cone beam CT. The evaluation included the radiologically found depth of prosthesis insertion within the vestibule, the vestibule depth, and the correlation with the bone conduction (BC) threshold, vertigo, and tinnitus. Results: Insertion depth varied between 0.2 and 1.6 mm (mean 0.74 mm). The ratio of insertion depth versus the vestibule depth was between 8% and 59% (mean 26.6%). We observed no correlation between the insertion depth, the length of the prosthesis, the ratio of insertion depth/vestibule depth, postoperative BC, appearance of vertigo, or tinnitus. Conclusions and significance: In our group, we observed no significant relation between insertion depth of the stapes piston, postoperative vertigo, tinnitus, or decrease of the BC.


Assuntos
Prótese Ossicular , Otosclerose/cirurgia , Cirurgia do Estribo , Feminino , Humanos , Masculino , Otosclerose/diagnóstico por imagem , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
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