Audiometric and Vestibular Function after Classic and Reverse Stapedotomy.

Background and Objectives: Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the surgical steps in stapedotomy impacts vestibular function and hearing improvement. Materials and Methods: A cohort of 123 patients underwent either classic or reverse stapedotomy procedures utilizing a fiber-optic argon laser. Audiological assessments, following the guidelines of the Committee on Hearing and Equilibrium, were conducted, including pure tone average, air-bone (AB) gap, overclosure, and AB gap closure. Vestibular evaluation involved pre- and postoperative comparison of rotatory test parameters, including frequency, amplitude, and slow phase velocity of nystagmus. Results: The study demonstrated an overall median overclosure of 3.3 (3.3, 5.0) dB and a mean AB gap closure of 20.3 ± 8.8 dB. Postoperative median AB gap was 7.5 (7.5, 11.3) dB in the reverse stapedotomy group and 10.0 (10.0, 12.5) dB in the classic stapedotomy group. While overclosure and AB gap closure were marginally superior in the reverse stapedotomy group, these differences did not reach statistical significance. No significant disparities were observed in the frequency, slow phase velocity, or amplitude of nystagmus in the rotational test. Conclusions: Although not always possible, reverse stapedotomy proved to be a safe surgical technique regarding postoperative outcomes. Its adoption may mitigate risks associated with floating footplate, sensorineural hearing loss, and incus luxation/subluxation, while facilitating the learning curve for less experienced ear surgeons.

High fluence in laser stapedotomy aggravates transient subjective dizziness.

BACKGROUND: Laser fenestration in stapedotomy has thermal effect to the vestibule. AIMS/OBJECTIVES: To evaluate the role of energy density (fluence) in the severity of postoperative vestibular symptoms. MATERIALS AND METHODS: The retrospective chart-review study included 84 patients with otosclerosis that underwent primary laser stapedotomy. Surgical outcomes, including nystagmus, and subjective vestibular symptoms during one-month follow-up, were compared between potassium titanyl phosphate (KTP) and CO2 laser. According to this study and literature, we assessed the relationship between laser parameters and the incidence of persistent vestibular symptoms lasting more than one week after surgery. RESULTS: The KTP and CO2 laser group included 48 and 36 patients, respectively. Fluence was different between the KTP (637 J/cm2) and CO2 (141 J/cm2) laser (p < .001). The KTP group showed gradual decrease in dizziness during one-month observation period, while the CO2 group exhibited a steep recovery curve in the first postoperative week (9 and 4 d of duration, respectively). The incidence of persistent vestibular symptoms was correlated with both fluence (r = 0.80, p = .01) and spot size (r = -0.74, p = .01). CONCLUSIONS AND SIGNIFICANCE: Appropriate setting of parameters with lower fluence is desirable for the efficiency and safety of laser stapedotomy.Abbreviations: ABG: air-bone gap; SD: standard deviation.

MRI Safety of Stapes Prostheses: A Systematic Review.

OBJECTIVE: To assess magnetic resonance imaging (MRI) safety of stapes prostheses. DATA SOURCES: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from inception to November 2021 following PRISMA guidelines. REVIEW METHODS: Studies reporting evidence of stapes prosthesis displacement or interaction in adult or pediatric implant recipients undergoing MRI. Cadaveric, animal, and basic studies with nonhuman data were also included. RESULTS: From an initial search of 123 articles, 42 full-text studies were evaluated for eligibility and 19 studies that met the inclusion criteria were included. Motion artifact was reported in a few stainless steel prosthesis types in vitro; however, such displacement was not observed in human cadaver temporal bone studies and had no adverse reported outcomes. A small subgroup of patients in the 1980s received a ferromagnetic stainless steel stapes implant that was recalled and has not been used since 1987. Patients with implants performed in the 1980s should be directed to 1.5T scanners from an abundance of caution. CONCLUSION: Modern (post-1987) stapes prostheses do not pose a risk in vivo when exposed to the magnetic fields of MRI scanners.

Linear transmission between malleus and stapes in cases with incus necrosis.

OBJECTIVE: The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction. METHODS: A retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation. RESULTS: The audiogram showed a post-operative air-bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same. CONCLUSION: The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique.

Primary stapedotomy: Influence of prosthesis diameter on hearing outcome

Objectives: To evaluate the success rate of primary stapedotomy and to investigate the influence of prosthesis diameter on hearing outcome.Material and methodsRetrospective medical chart review of 125 cases who underwent primary small fenestra stapedotomy, from January 2001 to December 2018. The study population was divided in two groups based on Teflon prosthesis diameter – .6mm (60%, N=75) and .4mm (40%, N=50). Pre- and postoperative (≥12 months) air-conduction (AC), bone conduction (BC) and air-bone gap (ABG) thresholds were compared.ResultsPostoperative ABG≤10dB and ≤20dB was achieved by 65.7% and 90% of the patients. A functional hearing (PTA-AC≤30dB) was achieved by 59.2% of patients. Sensorineural hearing loss (SNHL, worsening in BC-PTA>10dB) was identified in 7.2% of patients. Comparison of the .6mm- and .4mm-groups, revealed no differences regarding improvements in AC-PTA (22.4 vs. 20.7dB, p=.56), BC-PTA (3.4 vs. 2.3dB, p=.54) and ABG-PTA (19.1 vs. 18.4dB, p=.77). Hearing outcome evaluation identified similar postoperative success rate (.6mm, 79.7% vs. .4mm, 62%, p=.336) and comparable functional hearing (.6mm, 64% vs. .4mm, 52%; p=.197). The incidence of postoperative SNHL was similar between the two pistons (.6m, 5.3% vs. .4mm, 10%, p=.481).ConclusionPrimary small fenestra stapedotomy is an effective and safe procedure. A postoperative ABG within 10dB was achieved in 67.2% of patients and there was a reduced incidence of sensorineural hearing loss. Hearing outcome was not influenced by diameter of the selected prosthesis. Postoperative bone conduction hearing thresholds did not differ between the groups, which revealed no significant inner ear trauma caused by the larger piston. Although we did not find evidence to suggest one piston over the other, our results showed a trend toward better results with the larger prosthesis. (AU)

Objetivos: Evaluar la tasa de éxito de la estapedotomía primaria, y estudiar la influencia del diámetro de la prótesis en el resultado auditivo.Material y métodosRevisión retrospectiva de historias médicas de 125 casos sometidos a estapedotomía primaria de la ventana oval, de julio de 2001 a diciembre de 2018. La población de estudio se dividió en 2 grupos, sobre la base del diámetro de la prótesis de teflón de 0,6mm (60%, N=75) y 0,4mm (40%, N=50). Se compararon los valores preoperatorios y postoperatorios (≥12 meses) de los umbrales de conducción aérea (AC), conducción ósea (OC) y desviación aérea-ósea (ABG).ResultadosEl 65,7 y el 90% de los pacientes lograron valores postoperatorios de ABG≤10dB y ≤20dB. Se logró audición funcional (PTA-AC≤30dB) en el 59,2% de los pacientes. La hipoacusia neurosensorial (SNHL, con empeoramiento en BC-PTA>10dB) se identificó en el 7,2% de los pacientes. La comparación entre los grupos de 0,6 y 0,4mm, no reveló diferencias en cuanto a las mejoras de AC-PTA (22,4 vs. 20,7dB; p=0,56), BC-PTA (3,4 vs. 2,3dB; p=0,54) y ABG-PTA (19,1 vs. 18,4dB; p=0,77). La evaluación del resultado auditivo identificó una tasa de éxito postoperatorio similar (0,6/79,7 vs. 0,4mm/62%; p=0,336) y una audición funcional comparable (0,6/64 vs. 0,4mm/52%; p=0,197). La incidencia de SNHL postoperatorio fue similar entre los 2 pistones (0,6/5,3% vs. 0,4mm/10%; p=0,481).ConclusiónLa estapedotomía primaria de ventana oval es un procedimiento efectivo y seguro. Se logró ABG postoperatoria dentro del rango de 10dB en el 67,2% de los pacientes, y se redujo la incidencia de hipoacusia neurosensorial. El resultado auditivo no se vio influido por el diámetro de la prótesis seleccionada. Los umbrales postoperatorios de conducción ósea no difirieron entre los grupos, lo cual reveló la ausencia de daño significativo en el oído interno causado por el pistón de mayor diámetro. (AU)

Prótese ossicular em orelha média: o que procurar?: [revisão] / Prosthetic ossicular on middle ear: what look?: [review]

O objetivo deste trabalho foi demonstrar os achados tomográficos normais e patológicos encontrados no pós-operatório de pacientes submetidos a implantes de prótese ossicular, avaliados retrospectivamente por tomografia computadorizada. A estapedectomia com inserção de prótese é considerada o método ideal em indivíduos com fechamento da janela oval secundário a otosclerosefenestral ou causas inflamatórias. Vários tipos de prótese são utilizados, dependendo da extensãoda doença e preferência do cirurgião. Os autores, após revisão da literatura, descrevem os achadospós-operatórios considerados normais e as várias complicações inerentes ao procedimentocirúrgico, incluindo perfuração da membrana timpânica, processo inflamatório pós-operatório, necrosecom subluxação ou extrusão da prótese, desenvolvimento de granuloma/colesteatoma oufibrose periprotética, fístula perilinfática, lesão do nervo facial, dentre outras. Os achados tomográficos relacionados ao pós-operatório, bem como às complicações supracitadas, são de grande importância para o conhecimento dos radiologistas, sendo imprescindível para a propedêutica diagnóstica uma estreita correlação clínico-cirúrgica.

The aim of this essay was to demonstrate the normal and pathological CT findings of the post-operative imaging of patients underwent ossicular prosthesis implants. The stapedectomy replacedby prosthesis is considered the “gold standard” treatment of patients with oval window closure, related to otosclerosis or otherinflammatory conditions. Several types of prosthesis are availableand the choice depends on the extension of the disease or thesurgeon’s preferences. Based on extensive literature review, thenormal postoperative findings, as well as some surgery inherentcomplications were described, including among others: perforationof the tympanic membrane, necrosis associated with subluxation/extrusion of the prosthesis. granuloma/cholesteatoma or periprosthetic fibrosis, perilymphatic fistula, facial nerve damage. The knowledge of post-operative and related complications CT findings is extremely useful for head and neck radiologist, but it is essentialfor an assertive diagnoses a close clinical correlation.

Estapedectomía, otitis media y meningitis recidivante / Stapedectomy, otitis media and recurrent meningitis

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Trastornos del gusto posestapedostomías / Post stapedectomy taste disorders

Introducción: En su trayecto por el oído medio el nervio cuerda del tímpano (CT), se ve expuesto a lesiones quirúrgicas. Los trastornos del gusto se presentan como posibles secuelas del daño sobre la CT, lo cual puede afectar la calidad de vida de los pacientes. En las estapedostomías, la CT debe ser movilizada frecuentemente, y a veces seccionada para accederá la platina del estribo. Objetivo: Evaluar la evolución temporal de los trastornos del gusto posestapedostomías y su correlación con la preservación de la CT. Material y método: Estudio retrospectivo entre los años 2002 y 2007. Se analizaron las fichas clínicas y protocolos operatorios en busca de preservación o sección de la CT durante la cirugía. Se aplicó un mini cuestionario para evaluar la función gustativa y su evolución en el tiempo. Resultados: La CT fue preservada en 131 pacientes (93 por ciento) y seccionada en 10 pacientes (7 por ciento). La incidencia de alteraciones del gusto fue 7,6 por ciento> (10 pacientes) en el grupo con preservación de la CT y 20 por ciento> (2 pacientes) en el grupo que se seccionó (p >0,05). Todos los pacientes tuvieron una recuperación completa en su función gustativa antes de 12 meses luego de la cirugía, siendo más rápida en el grupo con preservación que en el que se seccionó la CT(5 meses versus 11 meses respectivamente). Conclusiones: Las alteraciones del gusto están presentes en pacientes sometidos a estapedostomías incluso cuando la CT es preservada. Cuando es seccionada no siempre se presentan trastornos del gusto, pero cuando están son más severos y duraderos.

Introduction: In its course through middle ear, the chorda tympani nerve (CTN) is potentially exposed to surgical injury. Possible sequels of CTN injury are taste disorders, which can affect the life quality of patients. During stepedectomies, the CTN often must be displaced or even severed in order to gain access to the stapes footplate. Aim: To assess the temporal evolution of post stepedectomy taste disorders and their correlation with CTN preservation. Material and Method: A retrospective study was conducted between 2002 and 2007. Medical records of 141 patients subjected to stapedectomy were analyzed in search for CTN preservation or section during surgery. A questionnaire was applied to evaluate postoperative taste function and its evolution over time. Results: CTN was preserved in 131 patients (93 percent) and sectioned in 10 patients (7 percent). The incidence of taste disorders was 7.6 percent (10 patients) in the CTN preserved group and 20 percent> (2 patients) in the CTN severed group (p>0.05). All patients had fully recovered taste function by 12 months after surgery, recovery being faster in the CTN preserved group than in the CTN severed group (5 months vs. 11 months respectively). Conclusions: Taste disorders may be present in patients subjected to stapedectomy even when CTN is preserved; taste disorders are more severe and long lasting in cases where the CTN is sectioned.

Cirugía de revisión de las estapedectomías / Revision stapedectomy

Objetivo: Determinar las causas del fracaso en la cirugía de revisión de la estapedectomía. Material y método: Se realizaron 23 cirugías de revisión de estapedectomías en el período comprendido entre enero de 2000 y abril de 2005. El tiempo transcurrido desde la primera cirugía varió desde un mínimo de 3 meses a un máximo de 25 años, con una media de 5,2 años. Los motivos más frecuentes de la revisión quirúrgica fueron, en primer lugar, los pacientes con cierre de umbral diferencial auditivo (UDA) inicial y pérdida auditiva posterior en el 56,52 %, y en segundo lugar, los pacientes sin ganancia auditiva inicial en el 39,12 %. Resultados: Los principales hallazgos quirúrgicos son los siguientes: prótesis corta en posición correcta (13,04 %), prótesis desplazada (60,87 %), bridas sobre la ventana oval (65,22 %), necrosis de rama larga del yunque (26,2 %) y platina reobliterada (26,09 %). En cuanto a los resultados audiométricos, obtuvimos un cierre completo del UDA en el 60,8 % (n = 14), cierre parcial del UDA del 13,2 % (n = 3), persistencia del UDA inicial en el 21,7 % (n = 5) y cofosis en el 4,3 % (n = 1). Conclusiones: La migración de la prótesis es la causa más frecuente de fracaso de la estapedectomía. Obtuvimos un cierre completo del UDA en dos tercios de los pacientes

Objective: The aim of the study was to determine the causes of failure in otosclerosis surgery. Material and method: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. Results: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). Conclusions: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients

Tratamento cirúrgico da otosclerose na residência médica / Surgical treatment of otosclerosis in medical residency training

A proporção de pacientes com otosclerose estapediana em relação ao número de otorrinolaringologistas tem diminuído nos últimos anos. Questiona-se se a cirurgia de tratamento da otosclerose deve ou não continuar sendo ensinada para residentes. OBJETIVO: Avaliar os resultados e complicações das estapedotomias realizadas por residentes no período de janeiro de 1997 a janeiro de 2000; verificar a inclusão da estapedotomia no programa de residência médica. FORMA DE ESTUDO: Estudo de coorte histórica longitudinal. MATERIAIS E MÉTODOS: Avaliados 50 prontuários de pacientes submetidos a um total de 51 estapedotomias quanto às complicações e resultados audiológicos. RESULTADOS: Fechamento do gap aéreo-ósseo para menor ou igual a 10dB NA em 70,5 por cento das orelhas e menor ou igual a 20 dB NA em 86,3 por cento das orelhas. Ocorreu 1 caso de surdez total. Complicações: subluxação da bigorna (7,8 por cento), perfuração da membrana timpânica (5,8 por cento), vertigem incapacitante que se resolveu dentro de 3 semanas (5,8 por cento), otorréia (3,9 por cento), platina flutuante (1,95) e fístula perilinfática (1,9 por cento). CONCLUSÃO: A análise da literatura e os resultados e complicações obtidos neste estudo permitem concluir que a estapedotomia pode ser incluída no programa de residência médica, desde que haja disponibilidade de casos cirúrgicos para o treinamento dos residentes.

The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM: the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS: fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS: there was closure of the air-bone gap within 10 dB HL in 70.5 percent of ears and closure to within 20 dB HL in 86.3 percent of ears. There was one ear with total hearing loss (2 percent). CONCLUSION: From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Resultados auditivos de estapedostomías en platinas complicadas / Hearing results on stapedostomies in complicated platens

La estapedostomía es una alternativa de tratamiento quirúrgico de la otoesclerosis altamente eficaz y con resultados estables a largo plazo. Uno de los factores que puede condicionar una peor ganancia auditiva postoperatoria es la presencia de alteraciones significativas en la platina del estribo. Se incluyen en este estudio pacientes con otoesclerosis que fueron sometidos a estapedostomía entre los años 2000 a 2005 y en los cuales se constató la presencia de platina obliterada o flotante. Se compararon los valores auditivos pre y postoperatorios con un grupo de referencia constituido por pacientes sometidos a estapedostomía en el mismo período con platina azul. Se incluyeron 14 pacientes, sin diferencias en edad y género con respecto a los controles. No existieron diferencias estadísticamente significativas entre los grupos en cuanto a umbrales de vía ósea, aérea ni diferencia óseo-aérea. No se presentaron complicaciones en esta serie. Estos resultados demuestran que una técnica quirúrgica apropiada, junto a la experiencia del equipo quirúrgico hacen de la estapedostomía una alternativa exitosa en este tipo de pacientes.

Manejo quirúrgico en otoesclerosis unilateral / Surgical handling of unilateral otosclerosis

La otoesclerosis es una de las formas de hipoacusia de conducción que puede ser corregida quirúrgicamente con buenos resultados auditivos. Respecto al manejo quirúrgico en otoesclerosis unilateral, no existe ningún tipo de publicación previa en la literatura mundial. El objetivo del presente trabajo es evaluar una serie clínica de 20 pacientes sometidos a tratamiento quirúrgico (estapedostomía o estapedectomía) por otoesclerosis unilateral, entre enero de 1987 y junio de 2003, en el Hospital Clínico de la Universidad de Chile. En relación a los resultados auditivos, el promedio total de las frecuencias de 500, 1.000 y 2.000 Hz mejoró para la vía aérea desde 60 dB en el postoperatorio, y con una reducción de la diferencia óseo-aérea desde 38 dB previo a la cirugía a 6 dB después de la intervención. Se presentaron complicaciones en 3 pacientes, específicamente platina flotante, pero sin resultados auditivos adversos. Podemos concluir que la cirugía en otoesclerosis unilateral, al igual que en la patología bilateral, es una alternativa de tratamiento segura, confiable y con buenos resultados auditivos. La elección entre cirugía o prótesis auditiva debiera ser tomada por el paciente bajo consentimiento informado.

Fístula perilinfática pós-estapedotomia / Perilymphatic fistula after stapedotomy

O autor apresenta casuística de 11 pacientes que apresentaram quadro clínico sugestivo de fístula perilinfática após a realizaçao de uma estapedotonia e analisa os seguintes fatores: sinais e sintomas encontrados; intervalo de tempo entre a estapedotomia inicial e o início dos sintomas; tipo de tratamento utilizado; e os resultados após o tratamento em relaçao à audiçao e às vertigens. A seguir faz revisao bibliográfica do assunto.

Granuloma posestapedectomía: revisión de cinco casos / Postestapedectomy granuloma: review of five cases

El granuloma posestapedectomía es una complicación de la estapedectomía de causa desconocida y consiste en una reacción inflamatoria de reparación excesiva; si no se diagnóstica y trata a tiempo, lleva a un daño irreversible del oído. Su incidencia en los reportes internacionales es de 0.6 a 3 por ciento. En este estudio se revisaron los expedientes de 450 estapedectomías realizadas en los últimos cinco años en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, encontrando cinco casos de granuloma posestapedectomía que corresponden a una incidencia de 1.11 por ciento. Se revisa el cuadro clínico, diagnóstico, tratamiento y pronóstico, además de analizar su probable etiología.

Residência médica em 2 anos em otorrinolaringologia: "deve o residente fazer estapedectomia?" / Medical residence in 2 years in otolaryngology: \"should the resident performe stapedectomies?\"

Foram realizadas 36 estapedectomias no período de dois anos no Hospital de Clínicas da Universidade Federal do Paraná por residentes em seu segundo ano de formaçäo. Nossos resultados foram de fechamento de gap em 69,4 por cento, melhora da audiçäo em 22,2 por cento com gap residual entre 10 e 30 dB e 8,4 por cento com piora auditiva. Em 3 pacientes obtivemos perfuraçäo residual no pós-operatória. Em virtude destes resultados näo satisfatório questionamos a validade deste treinamento procurando justificativas e soluçöes para estes problemas

Correlación entre el umbral de descenso de la conducción ósea, en las curvas audiométricas, y los valores de discriminación logoaudiométricas en pacientes estapedectomizados

Analizamos el comportamiento de los valores de discriminación del lenguaje en pacientes con otoesclerosis sujetos a estapedectomía, y que muestran caídas en las frecuencias altas en el post-operatorio. Comparamos estos audiogramas con audiogramas de pacientes con hipoacusia sensorineural, los cuales fueron tomados como controles debido a la similitud de las curvas audiométricas. El comportamiento post-operatorio de la discriminación va relacionada con el mayor o menor descenso de la curva audiométrica hacia las frecuencias altas, a mayor slope menor discriminación. La presencia de valores de umbral slope O o negativos, presentan mejoría en la discriminación de un diez por ciento (10%)