Outcome of malleo-stapedotomy using the malleus relocation technique during revision stapes surgery.

OBJECTIVE: This study aimed to use a new otological technique, malleus relocation, to solve the problems of ossicular reconstruction undertaken during revision stapes surgery for incus necrosis. STUDY DESIGN: Prospective study of 12 patients undergoing revision stapedectomy for incus necrosis, in the otolaryngology department of Mansoura University, Egypt. PATIENTS AND METHODS: Twelve patients underwent ossiculoplasty between June 2004 and June 2007, as part of revision surgery for otosclerosis with incus necrosis. All patients underwent ossiculoplasty using the malleus relocation technique. Ossiculoplasty used the patient's own, necrosed incus between the relocated malleus and the footplate. RESULTS: Post-operative air-bone gap closure to within 10 dB was achieved in seven patients (58.3 per cent). An air-bone gap of less than 20 dB was obtained in 10 patients (83.3 per cent). Deterioration of bone conduction by 10 dB occurred in one case. No patients were left with a 'dead ear'. Patients' hearing was stable throughout the follow-up period (range six to 40 months; mean ± standard deviation 23.5 ± 12.8 months). CONCLUSION: These findings indicate that malleus relocation, performed during revision stapes surgery, is a safe and efficient technique for the treatment of incus necrosis.

Stapedotomy: does prosthesis diameter affect outcome?

Two hundred ears with otosclerosis have been operated upon using a 0.4-mm diameter Teflon platinum piston in 100 ears and a 0.6-mm diameter Teflon piston in the other 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the 0.6 mm group for all frequencies except at 2000 Hz, the differences were statistically insignificant except at 4000 Hz. The mean postoperative air-bone gap was 8.6 dB and 7.4 dB for the 0.4 and 0.6 mm groups, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB, there was a deterioration of more than 10 dB in three ears, one in the 0.4 mm group and two in the 0.6 mm group. According to our results, we conclude that the 0.4 mm and the 0.6 mm Teflon prostheses produce the same hearing improvement in stapes surgery for otosclerosis.

Far-advanced otosclerosis.

Patients with 'far-advanced' or 'very far-advanced' otosclerosis have a profound bilateral hearing loss, with apparently no cochlear reserve measured by standard clinical audiometers. These patients have no benefit from a powerful hearing aid, have severe feedback problems and the cochlear implant may be the only solution. A total of 12 stapedotomies were performed in 8 patients with far-advanced or very far-advanced otosclerosis, with satisfactory results, improved air conduction thresholds and improved cochlear function and speech discrimination. Stapedotomy is a useful procedure for patients with far-advanced otosclerosis which improves patient's hearing to levels where they can benefit from less powerful hearing aids with fewer feedback problems, compared to no measurable preoperative hearing aid benefit. It also spares those patients being submitted to cochlear implantation.

Cochlear function after stapedectomy.

The short-term and long-term results of stapedectomy for eliminating the conductive element and improving the hearing in patients with otosclerosis are highly satisfactory all over the world. The delayed sensorineural hearing loss which continues after successful stapedectomy may be due to the operation itself or due to the natural history of the disease. The study was conducted on 80 patients with unilateral stapedectomy with a minimal follow-up period of 1 year. We found that bone conduction values at each frequency in operated ears were stable with marked improvement at 2,000 Hz, on the other hand, the bone conduction thresholds in non-operated ears significantly deteriorated (p less than 0.001). The speech discrimination score was significantly improved in the operated group (p less than 0.001). An explanation for the cochlear changes in operated and non-operated ears is presented.

Blink reflex: prognostic value in acute peripheral facial palsy.

The blink reflex (BR) has been studied during the first 2 weeks in 122 patients with Bell's palsy and Ramsay Hunt's syndrome. According to early BR (R1), the patients were divided into 3 groups: R1 less than or equal to 13 ms (16 cases); R1 greater than 13 ms (54 cases), and absent BR (52 cases). There was a remarkable tendency towards a satisfactory recovery from paralysis if BR occurred during the first 2 weeks from onset (p less than 0.001). In patients with normal BR, 93.7% had a satisfactory recovery, and in patients with delayed R1, the prognosis was still good: 86.8% had a satisfactory recovery. When the reflex was absent a bad prognosis was given in 55.8% of the patients. The BR and the severity of the lesions according to electroneurograms was tested in 111 patients and found to be significantly correlated (p less than 0.001). BR seems to be a useful index for predicting the prognosis in an early stage of the paralysis, however, more than one test should be performed at the same time to accurately establish the prognosis.

Bilateral simultaneous Bell's palsy. Two cases following herpes simplex gingivostomatitis.

Bilateral simultaneous Bell's palsy (BSBP) is an infrequent clinical presentation. Two patients with BSBP following a recent herpes simplex gingivostomatitis are described. From a clinical point of view, these cases support the concept that Bell's palsy may be a partial manifestation of a generalized polyneuropathy, and most probably caused by a reactivated latent herpes simplex virus.