Comparison of stapedotomy minus prosthesis, circumferential stapes mobilization, and small fenestra stapedotomy for stapes fixation.

OBJECTIVE: To compare the outcomes of 3 surgical techniques for primary stapes fixation: stapedotomy minus prosthesis (STAMP), circumferential stapes mobilization (CSM), and small fenestra stapedotomy (SFS). STUDY DESIGN: Retrospective review of 277 primary cases operated for stapes fixation from 1997 to 2007. SETTING: Tertiary academic center. PATIENTS: Consecutive adult and pediatric cases operated for conductive hearing loss because of stapes fixation. INTERVENTIONS: STAMP was performed for otosclerosis limited to the anterior footplate, CSM was conducted for congenital stapes fixation, SFS was performed for more extensive otosclerosis or anatomic contraindications to STAMP/CSM. MAIN OUTCOME MEASURES: Pure-tone audiometry was performed preoperatively and postoperatively (3-6 wk) and the most recent long-term results (≥ 12 mo). RESULTS: Ninety-nine ears in 90 patients had audiologic follow-up data over 12 months. Sixty-seven ears (68%) underwent SFS, 16 (16%) STAMP, and 16 (16%) CSM. There was significant improvement in average air conduction (AC) thresholds and air-bone gap (ABG) for all techniques. Mean ABG for SFS closed from 29 to 7.1 dB (SD, 6.0), for STAMP from 29 to 3.8 dB (SD, 5.8 dB), and for CSM from 34 to 20 dB (SD, 8.2 dB). AC results were better in the STAMP than in the SFS group, especially in high frequencies. Bone conduction improvements were seen in all groups, highest in STAMP (4.3 dB) and CSM (3.8 dB) groups, but the differences between groups were not statistically significant. CONCLUSION: Satisfactory hearing results were achieved with all the techniques, and STAMP showed better hearing outcomes, especially in high frequencies. CSM is a good option for children and patients in whom it is desirable to avoid a footplate fenestration or prosthesis. CSM and STAMP had significantly higher rates of revision for refixation than SFS.

[A new method for the fixation of sound-conducting elements of the middle ear during ossiculoplasty].

The objective of the present work was to estimate the possibilities of the application of platelet-enriched plasma as a filtering material for ossiculoplasty. The results of surgical interventions on 120 patients presenting with chronic suppurative otitis media are reported. All the patients underwent closed-type sanation surgery (differential atticoanthrotomy) including either complete or partial restoration of the sound conduction mechanism in the middle ear. Platelet-enriched plasma was applied into the tympanic cavity of 55 patients as a fixing material for the reconstruction of the chain of the auditory ossicles. Ossiculoplasty without additional fixation was performed in 65 patients comprising the control group. The results of the study indicate that a clot of platelet-enriched plasma may be a good fixing material for the reconstruction of the entire chain of auditory ossicles and can be used for all types of ossiculopasty.

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.

Clinical consequences of feedback on ear surgery: the continuous recording of adverse events and complications with regard to reducing the number of surgeons who perform otosclerosis surgery.

Electronically stored data may be used to generate feedback overviews. This paper describes a method for establishing a picture of ear surgery complications. In this prospective study, the working definition of adverse events and complications is "incidents that are not intrinsic to the surgical procedure and that have a potential or actual negative effect on surgical outcome or postoperative morbidity". A simple method is used to categorise otologic adverse events and complications. This scale varies from adverse events (grade A) to death (grade D). All adverse events and complications in ear surgery that met this definition were documented electronically as part of continuous follow-up between 1 July 1992 and 30 June 1999. In the first 3 years, 1,009 ear operations were performed, and in 51 (5%) of them, adverse events or complications were noted during or after surgery. There were 30 (3%) grade A (adverse events), 18 (2%) grade B (minor complications), 3 (0.3%) grade C (major complications) and no grade D complications. Otosclerosis surgery was evaluated additionally, because halfway through a 7-year period, the number of surgeons was changed. Only three experienced, senior members of staff were involved, and inexperienced residents no longer were allowed to perform this kind of surgery. The reduction of surgeon numbers did indeed improve the outcome of the stapes surgery. Our results were comparable to the literature. This monitoring of outcome-results in relation to changes in care can be seen as a study of care quality. A review of this kind links daily clinical practice to the literature and induces an improvement in quality.

[Evaluation of stapes prosthesis biocompatibility]. / Ocena biologicznej tolerancji protezki strzemienia.

We reported patient suffering from otosclerosis, who was reoperated after 18 years. During the reoperation we did not observe any changes of intolerance, but histological examination of removed tarflen prosthesis showed foreign body reaction.

[Stapedectomy and micro-stapedotomy in the treatment of otospongiosis. A comparative study]. / Stapédectomie et micro-stapédotomie dans le traitement de l'otospongiose. Etude comparative.

This is a comparative study of 622 patients undergoing either stapedectomy or stapedotomy for otosclerosis. 379 underwent stapedectomy, which in the majority of cases employed interposition of the posterior crus of the stapes into a venous graft placed over the newly created fenestra. The results of this technique are compared with 243 microwindow stapedotomies performed since 1976. For all patients a minimum of 5 years had elapsed between surgery and evaluation of outcome. In some instances, this time period was 20 years. One month post-surgery the closure of the air-bone gap was more frequently superior with stapedectomy, particularly in the low frequencies. The degree of an incidence of overclosure was comparable for both techniques. However, at 4,000 Hz, bone threshold levels deteriorated more usually following stapedectomy. The air-bone gap widened progressively over the proceeding years post-stapedectomy. This was in contrast to the effect seen during the same period after stapedotomy, namely a narrowing of the air and bone threshold levels. Additionally a progressive loss of bone thresholds was noted after the latter technique. The incidence of sudden total deafness, either immediate or delayed, was less than 1% for both procedures. Even after 15 years or more poststapedectomy, the air-bone gap (13 dB average) and bone thresholds remained stable. Revision surgery was necessary in 8% of stapedectomies and in 4% stapedotomies. However, the post-operative follow up period is much shorter for the latter.

Vertigo in postoperative follow-up of otosclerosis.

Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.