Absent pyramidal eminence and stapedial tendon associated with congenital stapes footplate fixation: Intraoperative and radiographic findings.

OBJECTIVE: Report an association between congenital stapes footplate fixation (CSFF) and radiological absence of the pyramidal eminence and stapedial tendon. PATIENTS: Children and adults with intraoperatively confirmed CSFF and an absent stapedial tendon. INTERVENTIONS: Computed tomography (CT); exploratory tympanotomy with stapedotomy. MAIN OUTCOME MEASURES: Absence of a pyramidal eminence and stapedial tendon aperture identified on preoperative CT that was confirmed intraoperatively. RESULTS: Eight patients with intraoperative confirmation of CSFF and absent stapedial tendon were retrospectively identified. The average preoperative bone conduction and air conduction pure tone averages were 19.6 dB (SD 15.6 dB) and 55.9 dB (SD 23.6 dB), respectively. The average air-bone gap was 36.3 dB (SD 17.9 dB) preoperatively. In the seven patients who underwent preoperative CT, all were consistently identified to have an absent or hypoplastic pyramidal eminence and absent stapedial tendon aperture at the pyramidal eminence. In six cases, the stapedial footplate appeared normal, while in one case the footplate appeared abnormal which correlated with severe facial nerve prolapse observed intraoperatively. All eight cases underwent exploratory tympanotomy and demonstrated intraoperative stapes footplate fixation, absent stapedial tendon and either absent or hypoplastic pyramidal eminence, which correlated with preoperative CT findings. CONCLUSIONS: This study identifies a clinically pragmatic association between an absent pyramidal eminence identified on high-resolution CT and the diagnosis of CSFF. In a condition that otherwise generally lacks distinctive radiological features, the absence of a pyramidal eminence on CT in a patient with nonprogressive, congenital conductive hearing loss may strengthen clinical suspicion for CSFF.

The use of a surgical planning tool for evaluating the optimal surgical accessibility to the stapedius muscle via a retrofacial approach during cochlear implant surgery: a feasibility study.

PURPOSE: During cochlear implant (CI) surgery, visual detection of the stapedius reflex as movements of the stapes tendon, electrically elicited via the CI, is a standard measure to confirm the system's functionality. Direction visualization of the stapedius muscle (SM) movements might be more reliable, but a safe access to the small SM is not defined. A new surgical planning tool for pre-operative evaluation of the accessibility to the stapedius muscle (SM) during a cochlear implantation (CI) via a retrofacial approach was now evaluated. METHODS: A surgical planning tool was developed in MATLAB using an image processing algorithm to evaluate drilling feasibility. A flat-panel computed tomography (CT) combining a rotational angiographic C-arm units with flat-panel detectors (Dyna-CT) was used. In total, 30 3D Dyna-CT-based temporal bone reconstructions were evaluated by automatized algorithms, generating a series of trajectories and comparing their feasibility and safety to reach the SM via a retrofacial approach. The predictability of the surgical planning tool results was tested in 5 patients. RESULTS: The surgical planning tool showed that a retrofacial access to the SM would be feasible in 25/30 cases. Moreover, the evaluation of the predictability of the results obtained with the surgical planning tool conducted during 5 CI surgeries confirmed the results. Both the surgical planning tool and the results on SM accessibility via retrofacial approach during CI showed that this is safe and feasible only when the SM-exposed area was > 25% of its total, the distance between the SM and the facial nerve was > 0.8 mm, and the surgical corridor diameter was > 3 mm. CONCLUSION: The surgical planning tool seems to be useful for the pre-operative evaluation of the accessibility to the SM during a CI surgery via a retrofacial approach. Further prospective studies are needed to validate the results in larger cohorts.

Endoscopic type 3 tympanoplasty: Functional outcomes in chronic otitis media / Timpanoplastia endoscópica tipo 3: resultados funcionales en la otitis media crónica

BACKGROUND: Type 3 tympanoplasty is the surgery of choice for middle ear reconstruction in cases where an integral stapes suprastructure and mobile footplate are present. OBJECTIVE: The objective of this study was to obtain functional results after endoscopic type 3 tympanoplasty in chronic otitis media. MATERIALS AND METHODS: Prospective study including 24 patients who underwent endoscopic type 3 tympanoplasty, using PORP for ossicular chain reconstruction (OCR) and cartilage graft for tympanic membrane reconstruction. Audiograms were made preoperatively, and 6 months after surgery. RESULTS: Dry, closed, self-cleaning ears were obtained in 91.7% of the cases. Mean preoperative air-bone gap (ABG) was 30.4dB, mean postoperative ABG was 16.7 dB, dB gain of 13.6dB. ABG closure rate to 20 dB or less of 79.2%, and to 10 dB or less of 29.2%. CONCLUSION AND SIGNIFICANCE: Endoscopic tympanoplasty and OCR is a valid option for surgeons who are comfortable with the use of endoscopes for middle ear surgery as it allows improved visualization of the prosthesis and graft placement during middle ear reconstruction. BACKGROUND: Type 3 tympanoplasty is the surgery of choice for middle ear reconstruction in cases where an integral stapes suprastructure and mobile footplate are present. OBJECTIVE: The objective of this study was to obtain functional results after endoscopic type 3 tympanoplasty in chronic otitis media. MATERIALS AND METHODS: Prospective study including 24 patients who underwent endoscopic type 3 tympanoplasty, using PORP for ossicular chain reconstruction (OCR) and cartilage graft for tympanic membrane reconstruction. Audiograms were made preoperatively, and 6 months after surgery. RESULTS: Dry, closed, self-cleaning ears were obtained in 91.7% of the cases. Mean preoperative air-bone gap (ABG) was 30.4dB, mean postoperative ABG was 16.7dB, dB gain of 13.6dB. ABG closure rate to 20dB or less of 79.2%, and to 10dB or less of 29.2%. CONCLUSION AND SIGNIFICANCE: Endoscopic tympanoplasty and OCR is a valid option for surgeons who are comfortable with the use of endoscopes for middle ear surgery as it allows improved visualization of the prosthesis and graft placement during middle ear reconstruction

INTRODUCCIÓN: La timpanoplastia tipo 3 es la cirugía de elección para la reconstrucción del oído medio en casos donde se encuentra íntegra la supraestructura del estapedio, y hay una platina móvil. OBJETIVOS: El objetivo de este estudio es obtener resultados funcionales tras timpanoplastias tipo 3 con abordaje endoscópico. MATERIALES Y MÉTODOS: Estudio prospectivo incluyendo 24 pacientes quienes fueron operados de timpanoplastia tipo 3 endoscópicas, usando una PORP como material de osiculoplastia, y cartílago como injerto de reconstrucción de membrana timpánica. Audiometrías tonales fueron hechas previas a la cirugía y 6 meses posterior a ella. RESULTADOS: Oídos cerrados, secos y autolimpiantes fueron obtenidos en el 91,7% de los casos. El GAP aéreo-óseo preoperatoria medio fue de 30,4 dB, la misma diferencia media postoperatoria fue de 16,7 dB. La reducción de GAP postoperatoria fue de 13,6 dB. La tasa de cierre de GAP a menos de 20dB o menos fue del 79,2% y a menos de 10 dB del 29,2%. CONCLUSIONES: La timpanoplastia y reconstrucción osicular con abordaje endoscópico es una técnica válida y segura cuando es usada por cirujanos que están cómodos con el uso de endoscopios en la cirugía de oído medio, como permite mejor visualización de la colocación de prótesis e injertos durante la cirugía

[Effect of the stapedius and tensor tympani muscles tenotomy on the quality of life of patients suffering from Ménière's disease]. / A musculus tensor tympani és a musculus stapedius ín átvágásának hatása a Ménière-betegségben szenvedok életminoségére.

Introduction: Tenotomy of the tendon of the stapedius and tensor tympani (TT) muscles is a minimal-invasive surgical therapeutic procedure in Ménière's disease (MD). It has been assumed that the TT medializes the stapes into the oval window, resulting in changes in perilymphatic pressures of the inner ear. By cutting the tendons of both middle ear muscles, they affect the pressure dynamics by not augmenting this pressure even further. Aim: The immediate and long-term investigation of the effect of middle ear muscle tenotomy on the quality of life of patients suffering from Ménière's disease, measured by the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (THI). Method: A follow-up study of 22 patients with definite, unilateral Ménière's disease had undergone tenotomy under general or local anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients. Statistical analysis: The statistical analysis was completed by using the IBM SPSS V24 software. Since the parameters did not show normal distribution, non-parametric test (Mann-Whitney U test) was used. The significance level was specified as p<0.05. Results: A statistically significant reduction of DHI scores was noted in all patients. The tinnitus significantly reduced and all of the patients mentioned improved symptoms of MD. Conclusion: Although the follow-up period is short, and the pathomechanism (decrease of stapes medialization in the oval window) is not exactly clear, tenotomy seems to be a successful promising surgical treatment method with a high reduction of dizziness handicap score in conservative therapy-resistant Ménière's disease. Orv Hetil. 2020; 161(5): 177-182.

Dyna-CT of the temporal bone for case-specific three-dimensional rendering of the stapedial muscle for planning of electrically evoked stapedius reflex threshold determination during cochlear implantation directly from the stapedius muscle via a retrofacial approach: a pilot study.

PURPOSE: Evaluation of 3D Dyna-CTs to improve cochlear implantation (CI) planning and intraoperative electrically elicited stapedius reflex threshold (ESRT) measurements. METHODS: A prospective observational cohort study was performed. Anonymized data collection of Dyna-CTs and CI surgeries in which a retrofacial approach was implemented to access the stapedius muscle. 3D Dyna-CTs of 30 patients and the intraoperative confirmation of the predication in 5/30 patients during CI surgery were evaluated. Inter-rater reliability was also analyzed along with the predictive value of this evaluation. RESULTS: 36 representative structures of the middle and inner ear and 3D renderings of the Dyna-CTs were evaluated by four otoneurological surgeons. Fleiss' kappa values for the evaluation of the visibility were high (> 0.7) for most of the anatomical structures. The stapedius muscle was visible in 90% of the cases. Using the 3D data, the retrofacial access to the stapedius muscles was estimated as feasible in 86.7%. Fleiss' kappa value of the evaluation of the accessibility was 0.942. The intraoperative exploration of the stapedius muscle confirmed the preoperative prediction in all five selected patients (four patients with predicted accessibility and one patient with predicted inaccessibility). CONCLUSIONS: The use of Dyna-CT and 3D rendering is a helpful tool for preoperative planning of cochlear implantations and ESRT measurements from the stapedius muscle via the retrofacial approach.

Manubrio-incudo-stapedioplasty for reconstruction of Austin-Kartush type B ossicular defects.

OBJECTIVE: Manubrio-incudo-stapedioplasty functional outcomes were compared to those of other methods for reconstructing Austin-Kartush type B ossicular defects. METHODS: Forty-two patients underwent Austin-Kartush type B ossicular defect reconstruction using: manubrio-incudo-stapedioplasty (13 patients), an autologous incus (19 patients) or a titanium ossicular replacement prosthesis (10 patients). For manubrio-incudo-stapedioplasty reconstruction, the malleus head was removed, the manubrium was relocated posteriorly and the incus short process was placed on the mobile footplate. The manubrium was placed on the incus body groove and bone cement was applied to stabilise the manubrium-incus junction. Pre- and post-operative hearing thresholds were assessed. RESULTS: The air-bone gap decreased from 25.9 ± 6.0 dB to 12.3 ± 5.0 dB (p < 0.05) in the manubrio-incudo-stapedioplasty group. The hearing gain was 13.6 ± 5.2 dB for manubrio-incudo-stapedioplasty, 3.4 ± 14.2 dB with the autologous incus, and 3.3 ± 11.07 dB with the titanium ossicular replacement prosthesis. Hearing improvement was greater for manubrio-incudo-stapedioplasty compared to the other reconstruction methods (p < 0.05). CONCLUSION: Manubrio-incudo-stapedioplasty resulted in satisfactory hearing outcomes in patients with Austin-Kartush type B ossicular defects. This technique can be considered a stable, inexpensive and effective method to reconstruct Austin-Kartush type B ossicular defects.

[Recent surgical options for vestibular vertigo]. / Aktuelle operative Therapie des vestibulären Schwindels.

Vertigo is not a well defined symptom but a heterogenous entity diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine and primary care physicians. Most vertigo syndroms have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe the development of surgical therapy for hydropic inner ear diseases, Menière disease, dehiscence syndroms, perilymphatic fistulas, and benign paroxysmal vertigo. At the end, we shortly introduce the most recent development of vestibular implants. Surgical vestibular therapy is still indicated for selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and indication for the different procedures going along with an adequate patient selection. In regard to the invasiveness and the possible risks due to the surgery, in depth individual counselling is necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but go along with a high risk for hearing loss. Therefore, residual hearing has to be included in the decission making process for a surgical therapy.

Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy - A case report.

Abnormal auditory sensations or tinnitus caused by abnormal middle ear muscle contraction are extremely rare and uncomfortable for patients. A 67-year-old man who performed paint and body work for cars presented at our hospital with complaint of an audible and annoying abnormal sound that was synchronous with the striking of his hammer against the metal of the car body during his work. The patient reported that the sound was audible of left ear with a split-second delay after his hammer struck the metal. Preoperative subjective and objective testing failed to reveal any abnormal findings in our case. The patient's symptom was successfully cured by selective transection of the stapedius tendon. The characteristic nature of tinnitus with a split-second delay after striking the metal helped our diagnosis and method of intervention in this case.

Arteria estapedial persistente / Persistent stapedial artery

No disponible

Endolymphatic sac surgery versus tenotomy of the stapedius and tensor tympani muscles in the management of patients with unilateral definite Meniere's disease.

This study aims to compare the outcomes of patients with Meniere's disease submitted to either endolymphatic mastoid shunt (ES) or tenotomy of the stapedius and tensor tympani muscles (TSTM). This is a retrospective chart review of patients treated with ES or TSTM between 2000 and 2010 and followed up for at least 12 months. The main outcomes were represented by: (1) vertigo class, hearing stage and functional level according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; (2) adjustment of dizziness handicap inventory (DHI) and (3) complete and substantial vertigo control using the Kaplan-Meier survival method. Sixty-three patients met the inclusion criteria: 34 underwent ES and 29 TSTM. The baseline demographic characteristics, the hearing stage, the functional level, the DHI and hearing levels were not different between the two groups. No significant difference in vertigo class was demonstrated: 66 % of TSTM patients attained class A compared to 44 % in the ES group (p = 0.14). Kaplan-Meier survival curves specific to class A showed significant differences, favoring TSTM (log-rank test, p = 0.022). TSTM patients demonstrated significantly improved functional level (p = 0.0004) and improved DHI scores (p = 0.001). Eight ES patients (25 %) demanded a second surgical attempt compared to none in the TSTM. Aural fullness was significantly improved in TSTM group (p = 0.01), while the difference in tinnitus improvement was non-significant. Hearing preservation was significantly better in TSTM group (p = 0.001). TSTM is a safe surgical procedure, with significant vertigo control rates, and important hearing preservation rates. More patients and longer follow-up are needed to support our preliminary findings.

Three-dimensional temporal bone reconstruction from histological sections.

OBJECTIVE: To produce a high-resolution, three-dimensional temporal bone model from serial sections, using a personal computer. METHOD: Digital images were acquired from histological sections of the temporal bone. Image registration, segmentation and three-dimensional volumetric reconstruction were performed using a personal computer. The model was assessed for anatomical accuracy and interactivity by otologists. RESULTS: An accurate, high-resolution, three-dimensional model of the temporal bone was produced, containing structures relevant to otological surgery. The facial nerve, labyrinth, internal carotid artery, jugular bulb and all of the ossicles were seen (including the stapes footplate), together with the internal and external auditory meati. Some projections also showed the chorda tympani nerve. CONCLUSION: A high-resolution, three-dimensional computer model of the complete temporal bone was produced using a personal computer. Because of the increasing difficulty in procuring cadaveric bones, this model could be a useful adjunct for training.

[Stapedoplasty in a HIV-infected patient].

This paper reports an observation illustrating the possibility of the successful surgical treatment of otosclerosis in a HIV-infected patient presenting with acquired immunodeficiency syndrome (AIDS) and positive response in the test for hepatitis C. The authors used the results of multispiral computed tomography (MSCT) of the temporal bones as a basis for the prediction of the outcome of the surgical intervention taking into consideration specific primary manifestations of HIV infection as well as immunological and virlogical responses to anti-retroviral therapy.

Shortened stapedius tendon: a rare cause of conductive hearing loss.

INTRODUCTION: Anomalies of the stapedius tendon have been reported to cause conductive hearing loss; in theory, such anomalies limit the movement of the stapes. OBJECTIVES: To demonstrate a rare cause of conductive hearing loss resulting from anomaly of the stapedius tendon and to compare the clinical findings of this patient to other stapedius tendon anomalies reported in the literature. METHOD: Case report of a single case of shortened stapedius tendon and a review of the English literature on stapedius tendon anomalies. RESULTS: This is a case report of a 15-year-old boy with shortened stapedius tendon causing unilateral hearing loss, accompanied by a review of the literature. Contrary to other reported cases, this patient did not have an ossified tendon, but rather an extremely short tendon. The boy regained normal hearing following excision of the stapedius tendon. CONCLUSION: A shortened stapedius tendon is a very rare diagnosis, yet it should be considered as a possible cause of conductive hearing loss.

Tenotomy of the stapedius and tensor tympani muscles reduces subjective dizziness handicap in definite Meniere's disease.

CONCLUSION: Tenotomy is a promising surgical alternative with a high reduction in dizziness handicap in the short and long term. OBJECTIVES: To investigate the immediate and the long-term effect of tenotomy of the stapedius and tensor tympani muscles on subjective dizziness as measured by the Dizziness Handicap Inventory (DHI). METHODS: A retrospective follow-up study of 42 patients with definite, unilateral Meniere's disease (19 males, 23 females, average age = 58.1 ± 14.1 years) had undergone tenotomy under general anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients, with postoperative follow-up ranging from 6 months to 9 years. Additionally, results were divided into three postoperative subgroups (A = 0-3 years, B = 3-6 years, C = 6-9 years). RESULTS: A statistically significant reduction of 48 DHI points, from a median preoperative DHI = 52 to DHI = 4 postoperatively, was noted (p < 0. 001). In all, 40/42 patients reported a reduction of dizziness handicap, while in 33/42 the difference was > 12 points. A statistically significant reduction of DHI scores was noted (A = 60, B = 34, C = 33) in all subgroups. It was also noted that the higher the preoperative DHI score, the greater the subjective success of the surgery.

Intra- and postoperative electrically evoked stapedius reflex thresholds in children with cochlear implants.

OBJECTIVES: The aim of this study was to investigate whether there is a significant correlation between intra- and postoperative electrically evoked stapedius reflex thresholds (eSRTs) in children with cochlear implants. METHODS: Sixty-five pediatric cochlear implant users were included in this study. All patients had congenital prelingual hearing loss. The round window approach was used in all patients. The eSRTs were intraoperatively measured using the 1st, 3rd, 6th and 12th electrodes of the cochlear implant. The measurements taken during the first fitting of the device were taken again one month after surgery. We used paired-sample t-tests to determine the correlation between intra- and postoperative eSRTs. RESULTS: The eSRT analysis revealed a statistically significant difference between the intra- and postoperative thresholds. A correlation analysis did not reveal any correlation between intra- and postoperative eSRTs. CONCLUSION: Intraoperative eSRT measurements were unable to predict early postoperative eSRTs.

A scanning electron microscopic study of crimping of stapedial prostheses.

OBJECTIVE: The aim of this study was to evaluate, through the Scanning Electron Microscopy, the loop closure of four types of stapedial prostheses and to compare the different systems of crimping to the long process of the incus. MATERIALS AND METHODS: Four types of stapedial prostheses (one platinum-teflon, two different titanium and one nitinol-teflon pistons) were inserted in 40 specially prepared temporal bones simulating the in vivo stapedotomy procedure. Two pistons were crimped by single manual manoeuvre with a McGee microforceps; the remainders were self-retained and thermal-crimped, respectively. All the specimens were evaluated through the Operative Microscopy and the Scanning Electron Microscopy. RESULTS: Through the Operative Microscopy, all prostheses apparently achieved a correct adhesion to the long process of the incus; on the contrary the Scanning Electron Microscopy study demonstrated some limits of the manual crimping and the different coupling with the ossicular chain of each type of stapedial prosthesis. CONCLUSION: A complete adhesion of the prosthetic loop cannot be obtained because of the irregular profile of the incus at the site of attachment of the stapedial prosthesis. Consequently, on the basis of the morphological analysis with Scanning Electron Microscopy, in the surgical practice, the preference could be given to the stapedial prostheses that achieve greater contact such as the self-retaining and thermal crimping pistons compared to the standard sized prostheses considered.

Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease.

CONCLUSIONS: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Meniere's disease - laying the foundation for future prospective, randomized controlled trials. OBJECTIVES: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere's disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective. METHODS: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere's disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each. RESULTS: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).

Intraoperative electrically evoked stapedius reflex thresholds in children undergone cochlear implantation: round window and cochleostomy approaches.

OBJECTIVES: To study the best electrically stimulation in cochlear implant surgery with round window (RW) and Promontory cochleostomy approaches with electrically evoked stapedius reflex thresholds (ESRT) intraoperatively. METHODS: Thirty-nine children underwent CI surgery were included for this study. The surgical procedures consisted of RW and Promontory cochleostomy. ESRT for each 1st, 3rd, 6th and 12th electrodes (E) were determined. Statistical evaluation was done for the comparison of the thresholds and duration times for both groups. RESULTS: The duration times of ESRT for E1, E3, E6 and E12 electrodes was shorter in RW group compared with the Promontory group (p<0.05). The statistical evaluation of ESRT measurements of E1, E3, E6 found p<0.001 and E12 electrode p<0.05 in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. CONCLUSION: The duration of electrically stimulation thresholds were shorter in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. RW insertion offers best electrically stimulation relative to electrode insertion via a promontory cochleostomy.

Tenotomy of the tensor tympani and stapedius tendons in Ménière's disease.

UNLABELLED: Tenotomy of the tensor tympani and stapedius tendons in Ménière's disease. OBJECTIVE: In Ménière's disease (MD), when patients have incapacitating vertigo that is resistant to drug treatment, an intratympanic gentamicin application (ITG) is often proposed. Recently, some authors suggested that tenotomy, sectioning of the tensor tympani and stapedius tendons, could be a promising treatment. We examined whether tenotomy (ST) has additional benefit, compared to ITG alone, with respect to tinnitus, vertigo, and quality of life. METHODOLOGY: We conducted a retrospective survey of the charts of 24 patients with MD who underwent ITG, or ITG plus ST. Baseline data and follow-up assessments were obtained, using the Ménière's Disease Outcomes Questionnaire (MDOQ), the Dizziness Handicap Inventory (DHI), vertigo frequency per month, tinnitus visual analogue scale, and functional level. Failure was determined by the need for an additional procedure. RESULTS: ITG was performed on 15 patients, and 9 patients underwent ITG plus ST. The procedure was sufficient in 53% of the ITG group and in 22% of the ITG plus ST group. No significant difference was found between the two groups concerning MDOQ scores, DHI, functional level, vertigo frequency, and tinnitus. In the ITG group, we found a significant improvement in number of vertigo attacks and the tinnitus visual analogue scale. In the ITG plus ST group, there was a significant reduction in vertigo attacks, but not in tinnitus. CONCLUSION: This preliminary study suggests no additional benefit of stapedius and tensor tympani tenotomy in the treatment of Ménière's disease patients.