A new device for real-time peroperative monitoring of ossicular chain reconstruction during middle ear surgery

Introduction: The aim of the middle ear surgery is to eliminate abnormalities from the mucous, ensure the due airing of the postoperative cavity and reconstruct the sound-conducting system in the middle ear. Numerous reports can be found in literature on the changes to bone conduction as a consequence of middle ear surgery. Study objective: The aim of the work is to define the factors that affect bone conduction in the patients operated on due to the perforation of the tympanic membrane with the preserved and normal mobile ossicular chain. Material and method: A prospective analysis of patients operated on due to diseases of the middle ear in 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were taken into consideration. The analysis encompassed the patients who had undergone myringoplasty. The patients were divided into several groups taking into account the abnormalities of the mucous observed during otosurgery. Results: A significant improvement of bone conduction was observed in the patients with dry perforation, without other lesions in the middle ear. The appropriate pharmacological treatment before otosurgery in patients with permanent discharge from the ear resulted in significant bone conduction improvement. The elimination of granulation lesions turned out to be a positive factor for the future improvement of the function of the inner ear. Conclusions: The lack of abnormalities on the mucous of the middle ear (e.g. granulation,) and discharge has a positive impact on improvement of bone conduction after myringoplasty. Adhesions in the tympanic cavity, especially in the niche of the round window, have a negative impact on improvement of bone conduction in patients after myringoplasty.

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Electrocoagulation improving bone cement use in middle-ear surgery: short-term and middle-term results

The Journal of Laryngology & Otology ◽

10.1017/s0022215116009014 ◽

2016 ◽

Vol 130 (12) ◽

pp. 1110-1114 ◽

Cited By ~ 3

Author(s):

C Galy-Bernadoy ◽

M Akkari ◽

M Mondain ◽

A Uziel ◽

F Venail

Keyword(s):

Bone Cement ◽

Ossicular Chain ◽

Stapes Surgery ◽

Middle Ear Surgery ◽

Hearing Improvement ◽

Short Term ◽

Ear Surgery ◽

Middle Term ◽

Ossicular Chain Reconstruction ◽

Revision Stapes Surgery

AbstractBackground:Bone cement is used for ossicular chain repair and revision stapes surgery. Its efficient use requires cautious removal of mucosa from the ossicles. This paper reports a technique for easy, fast and safe removal of this mucosa prior to cement application. It consists of the application of monopolar electrocoagulation on the ossicles prior to bone cement application.Methods:The outcomes of six cases of revision stapes surgery and seven cases of partial ossiculoplasty, conducted between 2007 and 2012 using this new technique, were evaluated. Intra-operative reports and audiometric data were collected.Results:During the last assessment, reconstruction using bone cement resulted in mean post-operative air–bone gaps of 4.1 ± 6.5 dB in revision stapes surgery cases and 5.7 ± 5.5 dB in partial ossiculoplasty cases, reflecting a significant hearing improvement (p = 0.03). No complications were observed.Conclusion:Electrocoagulation allows the removal of mucosa from the ossicles in an easy, fast and safe manner, enabling the use of bone cement for ossicular chain reconstruction.

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Auditory Brain Stem Response Monitoring during Middle Ear Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800807 ◽

1989 ◽

Vol 98 (8) ◽

pp. 605-610 ◽

Cited By ~ 1

Author(s):

Jobst von Scheel ◽

Dieter Mrowinski ◽

Günther Gerull ◽

Josef Thoma

Keyword(s):

Brain Stem ◽

Middle Ear ◽

Ossicular Chain ◽

Simultaneous Recording ◽

Response Monitoring ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Auditory Brain Stem Response ◽

Auditory Brain Stem ◽

Conductive Hearing

Conductive hearing loss can be determined in the course of middle ear surgery by sound probe stimulation and simultaneous recording of auditory brain stem responses. Mechanical properties of the ossicular chain, usually judged subjectively by the surgeon's visual and tactile senses, can be quantified objectively. Thus, disarticulation of ossicles can be localized precisely, and fixation of the head of the malleus can be differentiated from stapes fixation. Moreover, the function of the reconstructed ossicular chain or prosthesis may be ascertained.

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Microendoscopic Surgery of Middle Ear and Petrous Bone: Benefits Analysis

Ear Nose & Throat Journal ◽

10.1177/0145561320930017 ◽

2020 ◽

pp. 014556132093001 ◽

Cited By ~ 1

Author(s):

Arturo Mario Poletti ◽

Lorenzo Salvatore Solimeno ◽

Giovanni Cugini ◽

Stefano Miceli ◽

Giovanni Colombo

Keyword(s):

Middle Ear ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Petrous Bone ◽

Tertiary Hospital ◽

Middle Ear Surgery ◽

Microscopic Approach ◽

Ear Surgery ◽

Glomus Tympanicum ◽

Double Technique

Objectives: Endoscopy has become routinely used in middle ear surgery. The aim of this study is to analyze where this tool may complement the traditional microscopic approach. This is a retrospective study done in single tertiary hospital. Methods: We reviewed 342 middle ear/petrous bone surgical procedures performed between 2005 and 2015. Only cases in which both microscopic and endoscope-assisted techniques were used have been included. Sixty-six patients received this double-technique surgery: 51 (77.2%) had middle ear/mastoid and petrous bone cholesteatomas (46 middle ear and mastoid and 5 acquired/congenital petrous bone cholesteatomas), 5 (7.5%) had glomus tympanicum tumors (GTT), 4 (6%) had an ossicular chain dislocation, 3 (4.5%) had purulent chronic otitis media, 2 (3%) had tympanosclerosis, and 1 (1.5%) had an ossicular chain malformation. Results: The endoscope was helpful to remove disease remnants not accessible by microscope in 41 (62%) of the cases; 37 (90%) were cholesteatomas, 3 (7%) were GTT, and only 1 (3%) was an open tympanosclerosis. In the remaining 25 (37.8%) cases, the endoscope was useful only to visualize the cavity since the microscope had already been successful in removing the entire lesion. Conclusions: The endoscopy can add valuable information and support to the usual microscope approach alone. The consensus of a single best technique does not yet exist, but the physician should choose the best modality or combination of modalities in order to cure the patient and prevent any possible complications or recurrence of the pathology.

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The classification of tympanomastoid surgery for cholesteatoma by the new SAMEO-ATO system in clinical practice

Otorinolaryngologie a foniatrie ◽

10.48095/ccorl202115 ◽

2021 ◽

Vol 70 (1) ◽

pp. 15-21

Author(s):

Michal Homoláč ◽

Tomáš Valenta ◽

Lukáš Školoudík ◽

Jan Mejzlík ◽

Viktor Chrobok

Keyword(s):

Clinical Practice ◽

Middle Ear ◽

Surgical Techniques ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Middle Ear Surgery ◽

Ear Surgery ◽

The Mean ◽

Comparison Of The Results

Introduction: The SAMEO-ATO system established by IOOG consensus in 2018 introduces a new, complex, and unified classification of middle ear surgery. This system is generally suitable for various surgical procedures in the middle ear. The main goal of this work is to present our experience of using the new classification system in the clinical practice focusing on cholesteatoma surgery. Methods: We have retrospectively classified the group of patients who underwent surgery for chronic otitis media with cholesteatoma between 2013 and 2017. Results: We classified 142 cholesteatoma surgeries carried out on 104 patients (56 men and 48 women at the age 5–77 years, with the mean 33 years and the median 27 years) using the SAMEO-ATO classification. There were 77 primary surgeries (S1), 40 second-look surgeries (S2p) and 25 secondary surgeries for recidivism (S2r). There was a 50% (20) incidence of recurrent cholesteatoma in S2p surgeries and 76% (19) incidence of residual cholesteatoma in S2r. We have further evaluated our group of patients by each SAMEO-ATO subclassification. In the mastoid part of surgery (parameter “M”), the combination of M1a + 2a (N = 49, 34.51%) was most frequent, followed by M2c (N = 25, 17.61%), M2a (N = 20, 14.08%), M1a (N = 4, 2.82%), M2b (N = 5, 3.52%), M3a (N = 3, 2.11%) and M3b (N = 1, 0.70%). In the ossicular reconstruction (parameter “O”), the most frequent was Osd (N = 58, 40.85%), followed by Ost (N = 21, 14.79%), Oft (N = 19, 13.38%), Ofd (N = 5, 3.52%) and Osm (N = 5, 3.52%). Conclusions: The SAMEO-ATO classifies various surgical techniques of cholesteatoma removal as well as reconstruction of the ossicular chain. It allows the creation of a unified database of patients who underwent middle ear surgery and the comparison of the results of different surgery techniques among various departments. The collected data are applicable for research purposes.

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Hearing loss in the Saethre-Chotzen syndrome

The Journal of Laryngology & Otology ◽

10.1017/s0022215100135443 ◽

1996 ◽

Vol 110 (10) ◽

pp. 952-957 ◽

Cited By ~ 11

Author(s):

Robbert J. H. Ensink ◽

Henri A. M. Marres ◽

Han G. Brunner ◽

Cor W. R. J. Cremers

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Ossicular Chain ◽

Middle Ear Surgery ◽

Ear Canal ◽

Ear Surgery ◽

Generation Family ◽

Ear Infections ◽

Conductive Hearing

AbstractA three-generation family with Saethre-Chotzen syndrome and an isolated case are presented. The proband presented with conductive hearing loss. His mother and grandmother showed minor features of the syndrome including conductive hearing loss.Symptoms of the craniosynostosis syndromes can include stapes ankylosis, a fixed ossicular chain in a too small epitympanum, and small or even absent mastoids. The proband was treated with a boneanchored hearing aid (BAHA) instead of reconstructive middle ear surgery. Current literature on the results of ear surgery is reviewed. In general, reconstructive middle ear surgery should only be considered if congenital anomalies of the middle ear are the only presenting symptom. In cases with additional anomalies such as atresia of the ear canal or damage due to chronic ear infections, the outcome of reconstructive surgery to correct the anomalous ossicular chain is unsatisfactory. In such cases the BAHA is probably the best solution.

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A New Intraoperative Real-time Monitoring System for Reconstructive Middle Ear Surgery

Otology & Neurotology ◽

10.1097/mao.0000000000001222 ◽

2016 ◽

Vol 37 (10) ◽

pp. 1601-1607 ◽

Cited By ~ 9

Author(s):

Thomas Zahnert ◽

Marie-Luise Metasch ◽

Hannes Seidler ◽

Matthias Bornitz ◽

Nicoloz Lasurashvili ◽

...

Keyword(s):

Real Time ◽

Monitoring System ◽

Middle Ear ◽

Middle Ear Surgery ◽

Real Time Monitoring ◽

Ear Surgery

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A cross sectional study to assess the role of preoperative HRCT temporal bone in CSOM: a comparison between middle ear surgeries with and without pre-op HRCT

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190046 ◽

2019 ◽

Vol 5 (2) ◽

pp. 273

Author(s):

Madhuri S. More ◽

Rahul B. Patel ◽

Jaymin A. Contractor ◽

Alpa P. Pipaliya ◽

Esha J. Desai ◽

...

Keyword(s):

Hearing Loss ◽

Temporal Bone ◽

Middle Ear ◽

Clinical Judgment ◽

Ossicular Chain ◽

Cross Sectional Study ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Cross Sectional ◽

Hrct Temporal Bone

Background: Importance of HRCT before middle ear surgery is proved by many published articles but most of the studies were done without evaluating the accuracy of clinical judgment at the same time.Methods: All the patients of CSOM in whom the middle ear surgery was planned were included in the study. Total number of sample size was 80 patients. Group A: 20 patients in which HRCT temporal bone was indicated as a routine evaluation before middle ear surgeries. Group B: 60 patients in which HRCT temporal bone was not indicated. Results: Maximum 43.75% (35) patients belong to 21 to 30 yrs. F: M is 1.5:1. Unilateral ear disease is more common (62.5%). 41.8% had mucosal type while 16.25% had squamosal type of COM. 77.5% ears found to have hearing loss. Conductive hearing loss was the most common (43.13%). HRCT in comparison with Intra-op had Kapa value of 1 (Aditus blockage & Tegmen erosion), 0.6 (sinus plate erosions), 0.5 (malleus, Incus, stapes erosions), 0.48 (Ossicular chain status), 0.46 (Scutum erosion), 0.4 (LSC fistula) and 0.3 (fallopian canal erosions. Clinical judgment in comparison with intra-op had kapa value of 1 (stapes erosion), 0.96 (aditus blockage), 0.79 (Incus erosion), 0.78 (malleus erosion) and 0.76 (ossicular chain status).Conclusions: Clinical judgment is as good as or even better than CT in presuming/detecting at least individual ossicular erosions, ossicular chain status, aditus blockage and HRCT temporal bone should be reserved for high risk and complicated cases.

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Taste Change after Middle Ear Surgery

Korean Journal of Otolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2009.52.5.401 ◽

2009 ◽

Vol 52 (5) ◽

pp. 401 ◽

Cited By ~ 1

Author(s):

Young-Ho Lee ◽

Mi-Kyung Ye ◽

Im-Hee Shin

Keyword(s):

Middle Ear ◽

Middle Ear Surgery ◽

Ear Surgery

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Ossicular chain reconstruction: endoscopic or microscopic?

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002728 ◽

2021 ◽

pp. 1-7

Author(s):

E A Guneri ◽

A Cakir Cetin

Keyword(s):

Word Recognition ◽

Middle Ear ◽

Risk Index ◽

Ossicular Chain ◽

Recognition Score ◽

Reconstruction Surgery ◽

Ossicular Chain Reconstruction ◽

Operation Duration ◽

Air Conduction

Abstract Objective To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. Methods Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air–bone gap, air–bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. Results Post-operative air conduction, air–bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air–bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air–bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). Conclusion Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

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