Anatomic variability of oval window as pertaining to stapes surgery

AbstractObjective:To establish the prevalence of stapes obliquity as observed in otosclerosis patients during stapes surgery by a simple method of intra-operative measurement.Design:Prospective observational study.Results:Intra-operative measurements showed that the mean distance (± standard deviation) between the horizontal segment of the facial nerve and stapes crura in 10 cases of otosclerosis was 0.74 mm (± 0.21 mm), whereas in 10 cases of non-otosclerosis the same distance was 0.20 mm (± 0.00). There was no gap (0 mm) between the stapes crura and inferior border of the oval window niche in otosclerotic ears, whereas in non-otosclerotic ears the same distance was 0.13 mm (± 0.05 mm). The differences were statistically significant (p < 0.0001).Conclusion:Obliquity and downward displacement of the stapes occurs in otosclerosis. It has diagnostic value as a new clinical sign in otosclerosis. The findings correlate with late complications and failures in stapes surgery. Methods to avoid these have been suggested.

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Effect of Aspiration of Perilymph during Stapes Surgery on the Endocochlear Potential of Guinea Pig

Otolaryngology ◽

10.1177/0194599811409516 ◽

2011 ◽

Vol 145 (5) ◽

pp. 801-805 ◽

Cited By ~ 13

Author(s):

Ryoukichi Ikeda ◽

Kazuhiro Nakaya ◽

Hidetoshi Oshima ◽

Takeshi Oshima ◽

Tetsuaki Kawase ◽

...

Keyword(s):

Hearing Loss ◽

Guinea Pig ◽

Inner Ear ◽

Oval Window ◽

Stapes Surgery ◽

Partial Recovery ◽

Cochlear Function ◽

Stapes Footplate ◽

Guinea Pig Model ◽

Temporal Bones

Objective. Suction applied to the vestibule through the oval window during stapes surgery is considered a primary risk for postoperative sensorineural hearing impairment. This study investigated the mechanism of acute phase change in cochlear function caused by aspiration of the opened oval window. Study Design. Guinea pig model. Setting. Academic hospital laboratory. Subjects and Methods. Guinea pigs were divided into 3 groups: stapes footplate removed without suctioning (6 animals), with indirect suctioning (5 animals), and with direct suctioning of the vestibular perilymph (6 animals). Endocochlear potentials (EPs) were measured at the second turn of the cochlea, and temporal bones were examined histologically. Results. Removal of the stapes footplate without suctioning caused little change in the EP (original value, 80.12 ± 3.52 mV), indirect suctioning caused minor decline of the EP of 9.14 ± 1.84 mV, and partial recovery ensued, whereas direct but gentle suctioning, resulting in dry vestibule, caused reduction in the EP of 16.38 ± 6.63 mV. Recovery was not observed or incomplete. No animals showed profound decrease in the EP. Conclusion. Gentle suctioning and removal of the vestibular perilymph can cause a mild decrease in the EP even without damaging the inner ear structures. Therefore, suctioning of the perilymph should be avoided during stapes surgery because acute hearing loss can result even without damaging the inner ear structures. However, hearing loss may not be profound, if suctioning is not vigorous enough to cause damage to the inner ear structures.

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Factors affecting hearing results after stapes surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215100144123 ◽

1999 ◽

Vol 113 (5) ◽

pp. 417-421 ◽

Cited By ~ 19

Author(s):

Hiromi Ueda ◽

Takashi Miyazawa ◽

Kiyomitsu Asahi ◽

Noriyuki Yanagita

Keyword(s):

Middle Ear ◽

Oval Window ◽

Stapes Surgery ◽

Study Group ◽

Hearing Results ◽

Factors Affecting ◽

Hearing Gain ◽

Close Relationship

AbstractFactors affecting auditory improvement after stapes surgery were investigated retrospectively on a study group of 106 otosclerotic ears (86 subjects). While the closure of the air-bone (A-B) gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and at frequencies lower than 1 kHz. Under 1 kHz, the lower the frequency, the worse the A-B gap after surgery. Stapedotomy and partial stapedectomy showed better post-operative hearing gain at 4 kHz than total stapedectomy. Total stapedectomy scored significantly better at 250 Hz and 500 Hz than stapedotomy. There was a close relationship between the pre-operative and post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at these frequencies. It was speculated that otosclerotic ears with a larger pre-operative airbone gap might have another lesion in the middle ear other than the oval window.

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Long-term results of revision stapes surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215100121498 ◽

1992 ◽

Vol 106 (11) ◽

pp. 971-973 ◽

Cited By ~ 11

Author(s):

Eero Vartiainen ◽

Juhani Nuutinen ◽

Jukka Virtaniemi

Keyword(s):

Revision Surgery ◽

Oval Window ◽

Stapes Surgery ◽

Long Term Results ◽

Surgical Trauma ◽

Hearing Results ◽

The Mean ◽

Revision Stapes Surgery

AbstractResults of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

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Latent superior canal dehiscence syndrome unmasked by stapedotomy for otosclerosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215109991654 ◽

2009 ◽

Vol 124 (4) ◽

pp. 428-430 ◽

Cited By ~ 17

Author(s):

A Hope ◽

P Fagan

Keyword(s):

Computed Tomography ◽

Middle Cranial Fossa ◽

Oval Window ◽

Stapes Surgery ◽

Vestibular Evoked Myogenic Potentials ◽

Vestibular Evoked Myogenic Potential ◽

High Resolution Computed Tomography ◽

Superior Canal Dehiscence ◽

Cranial Fossa ◽

Canal Dehiscence

AbstractObjective:This report describes a novel case in which superior canal dehiscence syndrome was unmasked by successful stapes surgery for otosclerosis.Methods:Case report and literature review regarding superior canal dehiscence syndrome.Introduction:Superior canal dehiscence syndrome is a rare but well described condition in which audiovestibular symptoms are caused by noise or straining. A dehiscence of the superior semicircular canal in the floor of the middle cranial fossa is responsible, and acts as a ‘third window’ into the inner ear.Case history:A patient with confirmed otosclerosis underwent second-side stapedotomy, with good audiometric outcomes. Unfortunately, surgery was complicated by immediate post-operative vertigo and persistent auditory symptoms. A diagnosis of superior canal dehiscence syndrome was eventually made, on the basis of low threshold vestibular evoked myogenic potentials and characteristic computed tomography findings. Superior canal resurfacing resulted in complete resolution of symptoms.Discussion:The otosclerotic focus in the oval window prevented the development of symptoms from this patient's superior canal dehiscence syndrome. Surgical stapedotomy created a third window and resulted in immediate post-operative imbalance and auditory symptoms.Conclusion:The diagnosis of superior canal dehiscence syndrome should be considered in patients with persistent audiovestibular symptoms after stapes surgery. High resolution computed tomography of the temporal bone and vestibular evoked myogenic potential testing, if available, are the investigations of choice in confirming the diagnosis.

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Role of stapes surgery in improving hearing loss caused by otosclerosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215106004257 ◽

2006 ◽

Vol 121 (5) ◽

pp. 438-443 ◽

Cited By ~ 3

Author(s):

M R Marchese ◽

G Paludetti ◽

E De Corso ◽

F Cianfrone

Keyword(s):

Pure Tone ◽

Functional Results ◽

Oval Window ◽

Stapes Surgery ◽

Hearing Results ◽

Pure Tone Average ◽

Group A ◽

The Mean ◽

Group B ◽

Operative Assessment

The aim of our study was to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of total stapedectomy in improving hearing in patients affected by otosclerosis.Three hundred and fifty-seven consecutive ears, in 265 patients affected by otosclerosis, underwent surgery. All cases underwent either primary small fenestra stapedotomy (group A, 196/357, 54.91 per cent) or stapedectomy (group B, 161/357, 45.09 per cent). After surgery, 256/357 (71.71 per cent) cases showed a 0–20 dB gap. There were no significant differences in hearing results between the two groups at either early or late post-operative assessment. The mean post-operative pure tone average and air–bone gap results were slightly greater for group B than for group A, at both early and late post-operative assessments, but these differences were not statistically significant. Therefore, in group A, the mean pure tone average at 4 kHz significantly improved, from 56.60 to 47.66 dB at early post-operative assessment and to 52.98 dB at late post-operative assessment.Our study suggests that the technique of microtomy of the oval window is able to improve hearing results especially at high frequencies.

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Revision Stapes Surgery: A Critical Evaluation

Otolaryngology ◽

10.1177/019459989411100414 ◽

1994 ◽

Vol 111 (4) ◽

pp. 473-477 ◽

Cited By ~ 16

Author(s):

Yasar Cokkeser ◽

Maged Naguib ◽

Miguel Aristegui ◽

Essam Saleh ◽

Mauro Landolfi ◽

...

Keyword(s):

Fibrous Tissue ◽

Critical Evaluation ◽

Ossicular Chain ◽

Oval Window ◽

Tissue Reaction ◽

Stapes Surgery ◽

Surgical Trauma ◽

Postoperative Results ◽

Revision Stapes Surgery ◽

Causes Of Failure

Fifty-six revision stapes surgeries performed during the last 9 years were evaluated retrospectively for their preoperative symptoms, intraoperative findings, and postoperative results according to the causes of failure, at the Gruppo Otologico, Piacenza, Italy. The most frequent causes of failure were found to be prosthetic misalignments, a reaction to the surgical trauma in the form of excess fibrous tissue reaction or new bony regrowth at the oval window, and ossicular chain problems. The location of the pathology was found to be an important factor in the outcome. Sixty percent of cases resulted in 0- to 20-dB air-bone gap. The causes of these failures, management, and their prevention during primary surgeries are also discussed.

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