Stapedotomy Removing Only the Stapes Head and Not the Entire Stapes Superstructure: Long-term Results.

OBJECTIVE: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results. STUDY DESIGN: Prospective study. PATIENTS: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical. RESULTS: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant. CONCLUSION: The Malafronte's stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

Partial Ossiculoplasty: Malafronte's Double Cartilage Block Versus Incus.

OBJECTIVES: To describe the outcomes of Malafronte's double cartilage block (mDCB) and incus autograft protheses, and to determine which prosthesis gives better and lasting hearing results. STUDY DESIGN: Prospective study. SETTING: ENT Department of AORN "S.G. Moscati" Avellino, Italy MATERIALS AND METHODS:: Partial columellar ossiculoplasties were performed on 102 patients. Malafronte's DCB was used on 58 patients (group 1). The reshaped autologous incus was used on 44 patients (group 2). The main follow-up for the whole study group was 4.5 years. MAIN OUTCOME MEASURES: Mean postoperative air-bone gap (ABG) closure to < 20 dB, incidences of prosthesis availability, prosthesis displacement from the tympanic membrane, and prothesis fixation to the middle ear walls. RESULTS: The hearing results and incidences of prosthesis availability, prosthesis slippage, and prosthesis fixation between groups 1 and 2 were significantly different. At the end of follow-up, a postoperative ABG of 20 dB or less occurred in 87.9% (n = 51) of patients in the group 1 and in 54.5% (n = 24) of patients in group 2. The Malafronte's DCB was always usable. While in 13.7% of cases, the incus was not usable. Prosthesis displacement and prothesis fixation were not observed in group 1. However, they were observed in 15 (34%) and 5 (11.3%) group 2 patients, respectively. CONCLUSION: The Malafronte's DCB gives more consistent hearing results. LEVEL OF EVIDENCE: 1b.

Stapedotomy: is the color of the footplate important in the choice of the type of perforator?

OBJECTIVE: To valuate the influence of the color of footplate in the choice of the type of perforator. STUDY DESIGN: Prospective study. Level of Evidence 1b. SETTINGS: Single hospital study in Avellino, Italy. SUBJECTS AND METHODS: From the first of September 2008 to the 30th of June 2009, we considered 83 patients affected by otosclerosis. Patients were divided into 2 groups under footplate perforator used. In the group A, manual perforators (the more traumatic drills) were used. In group B, CO2 laser (the less traumatic drill) was used. The 2 groups under the color of visible portion of the footplate before removing the stapes superstructure were divided in 2 subgroups. Group IA includes 33 blue footplates and Group IIA 10 white footplates. Group IB includes 30 blue footplates and Group IIB 10 white footplates. We estimated whether there is statistical correlation between type of perforator, incidence of footplate complications, and color of footplate. RESULTS: In group IA, we had 0 complications. In group IB, we had 0 complications. In group IIA, we had 7 complications. In group IIB, we had 2 complications. Comparison of incidence of footplate complications showed no statistical significance between group IA and IB and statistical significance between group IIA and IIB. CONCLUSION: The footplate color is important in the choice of the type of perforator.

Fisch's reversal steps stapedotomy: when to use it?

OBJECTIVE: To determine that the use of Fisch's reversal steps stapedotomy is recommended only when the visible portion of the footplate is blue in all its points before removing the stapes superstructure. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: This study started on January 2007 and ended on June 2007, when the statistical data reached significance. Fifty patients with otosclerosis were examined. Four otosclerosis were excluded from the study following the exclusion criteria indicated by Fisch (obliterative otosclerosis and narrow oval niche). Finally, 46 otosclerosis patients were considered for the study. For all patients, stapedotomy procedures using the reversal steps technique by Fisch were planned. The study group was divided into 2 groups (A and B) on the basis of the footplate color before removing the stapes superstructure. Group A included otosclerosis with blue footplate (n = 34). Group B included otosclerosis with white footplate (n = 12). We estimated whether the reversal steps stapedotomy proposed by Fisch significantly avoids incus complications (luxation and subluxation) and stapes footplate complications (luxation and fracture) both in blue and white otosclerosis. MAIN OUTCOME MEASURES: Footplate color, incidence of complications. RESULTS: The footplate fenestration had not caused fractures or luxation of footplate in both groups. The fracture of the anterior crus had caused 5 footplate complications (2 luxations and 3 fractures) in Group B, but none in Group A. This difference was significant. In Group A, we had no subluxation/luxation of the incus. In Group B, we had 3 incus subluxations. This difference was significant. CONCLUSION: The use of Fisch's reversal steps stapedotomy is recommended only when the visible portion of the footplate, before removing the stapes superstructure, is blue in all its points, that is, "blue otosclerosis," because only in this case that the original idea of Fisch avoids incus and footplate complications. When the visible portion of the footplate, before removing the stapes superstructure, is white in all or in most of its points, that is, "white otosclerosis," the reversal steps technique by Fisch is not recommended because it does not avoid incus luxation/subluxation and footplate complications (fracture and luxation of the anterior half).

New macroscopic classification of stapedio-ovalar otosclerosis: a simplified rating for training in stapedotomy.

OBJECTIVE: To have a new macroscopic classification of otosclerosis based on appearance variations of the stapes footplate due to the disease and to determine if the color variations are correlated to a minor or major incidence of footplate complications. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: From January 2006 to December 2006, 106 patients affected by otosclerosis underwent surgery. Three revision procedures (1 primarily operated in our department and 2 elsewhere) were excluded from the study. We finally considered 103 surgical procedures. In all patients, the appearance of stapes footplate before removing superstructure was assessed to determine a simplified rating of stapedial otosclerosis. We then excluded from the study group 7 patients in which the footplate was not visible (obliterative otosclerosis). Finally, we considered 96 otosclerosis patients divided into 2 groups (Groups A and B) that differed only in footplate color. Group A included 74 otosclerosis patients with blue footplate (77%), and Group B included 22 otosclerosis patients with white footplate (23%). We planned a stapedotomy procedure for all patients of Groups A and B. The surgeon, anesthesia, approach, succession of surgical steps, and type of surgical instruments were the same in all patients. We estimated whether there is statistical correlation between the incidence of footplate complications (floating footplate and footplate fracture) and the color variations of the stapes footplate in Groups A and B. MAIN OUTCOME MEASURES: Color footplate, incidence of footplate complications (floating and fractures footplate). RESULTS: The visible portion of stapes footplate before removing superstructure preserves the natural blue color in all its points in 71.84% of patients (n = 74). In 21.36% of patients (n = 22), the footplate appears white in all or in most of its extent. In 6.8% of patients (n = 7), the footplate was not visible because it was covered by massive otospongiotic tissue. Comparison of incidence of footplate complications between Groups A and B showed statistical significance. The incidence of footplate complications is higher in white otosclerosis than in blue otosclerosis. CONCLUSION: Based on the appearance and, furthermore, on the color of the visible portion of stapes footplate, before removing superstructure, the authors have formulated a new classification of otosclerosis: blue otosclerosis (blue footplate), white otosclerosis (white footplate), and obliterative otosclerosis (nonvisible footplate). The advantage of this classification is that it consents, before making any manipulation on the stapes, a rapid and simple identification of the different degrees of difficulty of surgery: I degree, blue otosclerosis; II degree, white otosclerosis; and III degree, obliterative otosclerosis.

A new double-cartilage block ossiculoplasty: long-term results.

OBJECTIVES: To determinate whether ossicular chain reconstruction performed with modified double-cartilage block (DCB) ossiculoplasty used by authors, leaving the intact perichondrium layer on the cartilage surface in contact with tympanic membrane, results in significant hearing results and prevents DCB displacement and DCB loss of stiffness when compared with the original DCB technique described by Luetje and Denninghoff. MATERIALS AND METHODS: Sixty-five ossicular reconstructions using DCB ossiculoplasty were performed from 1996 to 2001 in the whole study group. Eight patients had an inadequate follow-up and were excluded from the study. In the first 25 cases, the original DCB ossiculoplasty technique described by Luetje and Denninghoff was performed (Group 1). In the second group, 32 modified DCB ossiculoplasties were performed. The same author performed all cases. The main follow-up for the whole study group was 7 years. Audiometric data were calculated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines. MAIN OUTCOME MEASURES: Mean postoperative air-bone gap closure to less than 20 dB, incidence of DCB displacement from tympanic membrane, and incidence of loss of DCB stiffness. RESULTS: Comparison data of hearing results, incidence of DCB slippage, and incidence of DCB loss of stiffness in the group performed with original technique and in the group with modified technique showed statistical significance. Successful rehabilitation (pure-tone average air-bone gap <20 dB) of conductive hearing loss was obtained in 48% of cases in Group 1 (original DCB) and in 81.2% of cases in Group 2 (modified technique). In the group with original DCB ossiculoplasty, the displacement of implant and its loss of stiffness occurred more often than in the second group. CONCLUSION: The modified DCB represents an excellent partial ossicular replacement prosthesis. The perichondrium layer left attached on the cartilage surface in contact with tympanic membrane increases the stability of DCB and prevents the displacement and the loss of stiffness of the cartilage. The modified DCB ossiculoplasty is easy to perform. Hearing results are satisfactory and lasting. The cost is null, and the tolerance is excellent.