History of Otosclerosis and Stapes Surgery.

The current advancements in otosclerosis therapy cannot be fully appreciated without studying the history, rediscovery, and modification of a once-forgotten procedure. The evolution of stapes surgery can be best summarized into 4 noteworthy eras: the preantibiotic era (which was forgotten and then rediscovered), the fenestration era (mainstreamed by Julius Lempert), the mobilization era (led by Samuel Rosen), and the modern stapedectomy era (revived and revolutionized by John Shea). Each era is unique with its own challenges and ingenious techniques to overcome what used to be among the leading causes of deafness.

Cirugía de la otoesclerosis: estapedectomía y estapedotomía / Surgery of otosclerosis: stapedectomy and stapedotomy

Objetivo: Caracterización de la experiencia quirúrgica reciente en el tratamiento de la otoesclerosis.Materiales y método: Revisión sistemática de la historia clínica de pacientes operados por el autordurante el período enero 2005 a diciembre 2009. Resultados: Desde enero de 2005 a diciembre de 2009 se realizaron 246 cirugías de estribo en 201pacientes con diagnóstico de otoesclerosis en la Clínica Rivas de Bogotá, Colombia. 230 fueronprocedimientos de primera intervención y 16 de revisión. Se realizaron 213 estapedotomías y 19 estapedectomías. Se reportan en 50 intervenciones (20,3%) complicación perioperatoria siendo en su mayor proporción las relacionadas con desgarro de la membrana timpánica o piel del conductoauditivo externo (CAE) (56%), luxación de la platina (26%) y otras causas 18%.Conclusiones: Se corrobora la tendencia de incidencia de otosclerosis en la población de mujeres y es aún mayor en los casos operados bilateralmente. La estapedotomía es el procedimiento de elección para la cirugía de la otosclerosis en nuestros pacientes. La estapedectomía total o parcial se realizasólo en casos excepcionales. Importancia clínica: Consideraciones sobre la técnica quirúrgica. Accesibilidad a base de datos internacional de otología.

Objective: To characterize the recent surgical experience to treat otosclerosis.Materials and methods: systematic review of the surgical record of patients that have been operated on by the author during the period of January, 2005 to December, 2009. Results: From January, 2005 to December, 2009; 246 stapes surgeries were performed in 201 patients who had been diagnosed with otosclerosis at Clínica Rivas from Bogotá, Colombia. 230 of these werefirst time interventions and 16 of them were revisions. 213 stapedotomies were performed and 19 stapedectomies. Perioperatory complications were reported in 50 of the surgeries (20.3%). Out of those 50 surgeries the ones with the highest proportion were the ones related to tears of the tympanicmembrane or of the skin of the external auditory canal (EAC), (56%), dislocation of the foot plate (26%) and other causes 18%. Conclusions: A tendency for the incidence of otosclerosis is corroborated in the women populationand is even higher in those cases that have been bilaterally operated on. Stapedotomy is the procedure of choice to surgically treat our patients suffering from otosclerosis. Total or partial stapedectomy is performed under in exceptional cases. Clinical interest: Considerations on the surgical technique. Accessibility to an International Databaseof Otology.

Phylogeny of the stapes prosthesis.

OBJECTIVE: To create the first ever stapes prosthesis phylogenetic tree for the evolution of the stapes prosthesis. STUDY DESIGN: Retrospective literature review, personal interviews. SETTING: University Medical Center. PATIENT: Not applicable. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Construction of a stapes prosthesis phylogenetic tree with branches capable of including all stapes prostheses. RESULTS: One hundred five different stapes prostheses were reviewed, starting with the first-ever prosthesis used in the first stapedectomy and continuing up to the present time. The stapes prosthesis family tree contains 4 main branches that allow for categorization of all the commercial prostheses currently used. Many examples of atavistic prostheses, single surgeon use, and dead-end characteristics exist. CONCLUSION: An overview of the complicated phylogenetic tree for stapes prostheses gives great perspective to the history of stapedectomy and insights into many characteristics that are useful for designing new stapes prostheses.

General history of stapedectomy.

The article gives an overview of the historical development of stapedectomy beginning with Kessel in 1876. Then, from the beginning to the middle of the 20th century, surgery on the oval window became obsolete, opening the way for an era of fenestration operations until Shea in 1956 performed the first modern stapedectomy using a Teflon stapes replacement prosthesis. Since then, numerous surgeons worldwide have used this procedure with great success. Many of them have contributed towards progressively refining the surgical techniques, e.g. by changing the total removal of the footplate for the less traumatic small fenestra stapedectomy or stapedotomy.

Evolution of stapedectomy prostheses over time.

The history of stapedectomy prostheses started in 1956, when John J. Shea first described the microsurgical technique of the stapedectomy procedure in which an otosclerotic stapes was replaced with a prosthesis made of Teflon. Over the years, the evolution of the prostheses was influenced by the changes in the microsurgical technique, materials used and technical properties. The materials evolved from Teflon, metal, to plastic, and most recently to gold and titanium. While initially the diameter of the pistons used was 0.8 and 0.6 mm, from the 1970s onwards, it has been becoming even smaller in order to ease the procedure and reduce the risk of inner ear damage. Improvement was made in the way the prosthesis is fixed to the long incus process, resulting in different solutions like Teflon memory effect, platinum and gold band, titanium-gold clip prostheses or nickel-titanium alloy. Eventually, the most decisive factor for successful surgery is surgical experience with a specific type of prostheses and the expertise in the microsurgery technique.

Teaching stapes surgery.

This paper is a review of concepts and methods presented as a tribute to a great pioneer and teacher, Harold Frederic Schuknecht. His book entitled Stapedectomy, published in 1971, is based on past experience of '6,200 stapedectomy operations over a period of 13 years' and on experience gained from teaching the procedure to numerous residents and fellows. His concepts are still valid and represent a solid base for teachers and students of this elegant but precarious procedure.

Importancia del láser en la técnica quirúrgica de la otosclerosis y sus resultados / Importance of laser in the surgical technique of otosclerosis and its results

Los autores plantean la utilización del láser en la cirugía. Se revisa la literatura, en la que se encuentran autores que nos hablan de las ventajas que supone la utilización de este instrumento. También se recogen nuevas tendencias en la cirugía del estribo. Se plantea la enseñanza de la cirugía de la otosclerosis, con diferentes criterios. Se refuerza la idea de que es dificil mejorar los rendimientos auditivos, ya que los que se obtienen con técnicas clásicas son excelentes, pero si que se mejora la comodidad y se disminuyen los riesgos

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient

Adam Politzer (1835-1920) and the description of otosclerosis.

In 1893, Adam Politzer was the first to describe otosclerosis as a specific disease fixating the stapes. The aim of this study is to follow Politzer's research to understand how he finally explained the mechanism responsible for the fixation of the stapes. Politzer conducted his preliminary research from 1862 to 1893. From the concept of a dry catarrh of the middle ear, the fixation of the stapes became progressively associated with a specific ossification in and around the footplate. Politzer presented his first results in 1893. He completed his research by concluding in 1901 that otosclerosis had become an independent disease and should have the right to its own chapter in otologic books. He selected the word otosclerosis to describe this new pathologic entity.

[Samuel Rosen (1897-1981): the originator of stapes mobilization]. / Samuel Rosen (1897-1981)--odkrywca mobilizacji strzemiaczka.

Samuel Rosen originator of the surgical procedure so called mobilization, was second only to Juliusz Lempert as one of the great modern discoverers of new surgical techniques in the treatment of otosclerosis. This was the result of a chance discovery during routine stapes mobility test of the ossiculat chain before fenestration. Rosen having had excellent scientific training and knowledge was well prepared to interpret accidental stapes mobility and so design a new surgical technique. This operation enabled thousands of patients with otosclerosis to regain their hearing. However, he did not receive widespread acclaim in his own country. He received many invitations from abroad, travelled to several countries around the world where he taught stapes mobility testing and demonstrated his surgical procedure. In 1957 he also visited Poland, where he was born. He did not however limit himself to microsurgery of the ear. He created a group of international scientists who on the basis of investigations carried out by some of them, in the quiet noiseless African bush demonstrated that not only hearing is protected and the ageing process of this sensory organ delayed but also the development of arteriosclerosis is slowed down that which is the root cause of more and more cases of heart disease which among other factors can be attributed to the noisy stress ridden world we live in. After much success and fame which he achieved throughout the world, the American Medical Association awarded Sam Rosen a gold medal in 1967. But this too was not widely accepted by all his colleagues in his own country. He died in 1981 in China.

[Historical analysis of otosclerosis surgery]. / Análisis histórico de la cirugía de la otosclerosis.

In the present work main surgical techniques used along the history to solve hypoacusis caused by otosclerosis (opening of the timpani box internal wall, <>, puncture of cephalorachidium liquid, etc.) are studied. Those which have been more spread due to their results are analyzed in more depth (fenestration of the horizontal semicircular ductus, stapes mobilization and stapedectomy).

[Juliusz Lempert (1890-1959): the author of the fenestration technique]. / Juliusz Lempert (1890-1958)--twórca fenestracji.

Juliusz Lempert was born in 1890 in Poland. A few years later the poor Jewish family emigrated to the United States. Lempert obtained his MD degree at Long Island Medical College, and soon after that established a small hospital of his own in Manhattan. Later he bought an old five-storey building and converted it into a new otological medical center, which he called Endaural Hospital. His life was rather difficult with the wave of antisemitism in the United States and the adversity which he encountered so many times. However his contribution to the microsurgical treatment of conductive deafness is immense. He elaborated and introduced a new method of mastoidectomy and, first of all, fenestration--a new one-stage surgical technique to be applied in cases of otosclerosis. This precise, sophisticated operation revolutionized surgical treatment. With a dentist's drill Lempert created a new window on the horizontal canal, in this way the sound wave could stimulate the inner ear. He was to call it "fenestration nov-ovalis". Lempert was never a member of any ENT society and worked in his hospital alone. When suddenly his only son was stricken with leukemia and died, Lempert was completely broken, and never returned to this work. The next blows were new operative methods of otosclerosis: stapes mobilisation introduced by Rosen and stapedectomy by Shea. He never accepted these new techniques. It was a painful experience for a surgical genius who had at so many times been hurt during his life. He could not believe that his fenestration was definitely gone. Lempert quickly deteriorated physically and mentally, and died in 1958.

Clinical otosclerosis and auditory exostoses in ancient Europeans (investigation of Lithuanian paleoosteological samples).

The purpose of this investigation was to establish the incidence of clinical otosclerosis and auditory exostoses in Lithuanian paleopopulations. The total sample consists of 4080 skulls, dating from the Neolithic to the C17th-C18th A.D., investigated visually, under magnification and radiologically. Eight cases of clinical otosclerosis and 22 of auditory exostoses were identified. The general epidemiology of otosclerosis (0.19 +/- 0.08 per cent) was established to be similar to contemporary populations. This suggests that there are no new aetiological factors attributable to our modern society. Clear diminution of the incidence of auditory exostoses from the 1st to the 2nd millenium A.D. (3.46 +/- 0.76 per cent, against 0.06 +/- 0.04 per cent, p < 0.001) and definite sexual differences (males: 1.21 +/- 0.28 per cent; females: 0.17 +/- 0.10 per cent, p < 0.001) were also noted. In general, auditory exostoses were found much more frequently than in recent populations.