scholarly journals Endoscopic and Robotic Stapes Surgery: Review with Emphasis on Recent Surgical Refinements

2022 ◽  
Author(s):  
Sean C. Sheppard ◽  
Marco D. Caversaccio ◽  
Lukas Anschuetz
Keyword(s):  
Gold Standard ◽  
Conductive Hearing Loss ◽  
Stapes Surgery ◽  
Clinical Use ◽  
Experimental Setting ◽  
Microscopic Technique ◽  
Robotic Technology ◽  
Microscopic Approach ◽  
Surgical Morbidity ◽  
Conductive Hearing

Abstract Purpose of Review Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery. Recent Findings While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized. Summary Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.

Fixation of the Anterior Mallear Ligament: Diagnosis and Consequences for Hearing Results in Stapes Surgery

2003 ◽  
Vol 112 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Alexander Huber ◽  
Takuji Koike ◽  
Vel Nandapalan ◽  
Hiroshi Wada ◽  
Ugo Fisch
Keyword(s):  
Finite Element ◽  
Hearing Loss ◽  
Vibration Amplitude ◽  
Conductive Hearing Loss ◽  
Stapes Surgery ◽  
Hearing Results ◽  
Functional Failure ◽  
Human Temporal Bone ◽  
Manual Palpation ◽  
Conductive Hearing

In the search for possible causes of unfavorable results after stapes surgery, the study reported here focused on the anterior mallear ligament, since it has been previously reported that partial mallear fixation (PMF) leads to functional failure in 38% of cases of stapes revision surgery. The aims of the study were to identify effective methods for the diagnosis of PMF and experimentally assess the conductive hearing loss that results from PMF. The study included vibration amplitude measurements of the ossicles by laser Doppler interferometry (LDI) in 19 patients and 5 fresh human temporal bone (TB) specimens. Analysis of their dynamic behavior was performed by finite element modeling (FEM). Similar, significant changes of manubrium vibration patterns for PMF were found by FEM calculations, in TB experiments, and in patients. We could identify PMF either before operation, using LDI, or during operation, by manual palpation. In the TB experiments and FEM calculations, the attenuation of the stapes displacement due to an isolated PMF was approximately 10 dB and frequency-dependent. Untreated anterior mallear ligament fixation produced a persistent air-bone gap of approximately 10 dB after stapedioplasty.

Rosen mobilization of the stapes: does it have a place in modern otology?

2006 ◽  
Vol 120 (12) ◽  
pp. 1067-1071 ◽  
Author(s):  
G Thiel ◽  
R Mills
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Stapes Surgery ◽  
Hearing Gain ◽  
Stapes Fixation ◽  
Conductive Hearing

We describe two patients with stapes fixation, in both of whom Rosen mobilization seemed to be the most prudent surgical choice. In both cases, a useful hearing gain was achieved initially. In the patient with otosclerosis, the conductive hearing loss recurred and a stapedectomy was subsequently carried out. In the patient with congenital stapes fixation, the hearing gain was maintained for two years eight months. We believe that this technique still has a place in stapes surgery in rare instances.

scholarly journals Endoscopic versus microscopic type 1 tympanoplasty in chronic suppurative otitis media- tubotympanic type

2020 ◽  
Vol 6 (4) ◽  
pp. 720 ◽  
Author(s):  
Kiran A. Deshmukh ◽  
Vinayak Kurle
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Conductive Hearing Loss ◽  
Chronic Suppurative Otitis Media ◽  
Medium Size ◽  
Microscopic Technique ◽  
Suppurative Otitis Media ◽  
Type 1 Tympanoplasty ◽  
Conductive Hearing

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media attributes to 71.6% of hearing impairment in which most of them only have central perforations without any ossicular erosion or middle ear pathology. There are insufficient explanations to conclude which technique is better for type 1 tympanoplasty. Hence the study was conducted to compare and analyze the endoscopic technique with conventional microscopic technique for performing type 1 tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> This prospective study was done at Basaweshwara teaching and general hospital attached to MR medical college, Kalaburagi from December 2015 to June 2017 after obtaining institutional ethical clearance. Patients were selected according to inclusion and exclusion criteria and randomly posted for surgery by either endoscopic or microscopic technique and results were analyzed.  </p><p class="abstract"><strong>Results:</strong> There were 60 patients in the study between 11-65 years with mean age of 28.85±10.87 years in which were 28 females and 32 were males. All patients were divided into 2 groups in which 30 underwent endoscopic and 30 underwent microscopic type 1 tympanoplasty. In this 46.7% of the patients had left ear conductive hearing loss whereas 31.7% of patients had right ear conductive hearing loss and 21.7% of the patients had bilateral conductive hearing loss which included 22 small perforations, 33 medium size perforations and 5 large perforations of pars tensa.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with negligible scar post operatively.</p>

Malleus Grip Prosthesis

1986 ◽  
Vol 95 (5) ◽  
pp. 531-534 ◽  
Author(s):  
Harold F. Schuknecht ◽  
Mary L. Bartley
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Stapes Surgery ◽  
Sensorineural Hearing ◽  
Follow Up Studies ◽  
Significant Change ◽  
Conductive Hearing ◽  
Selection Of

The malleus grip prosthesis is designed for ears with conductive hearing loss caused by pathologic conditions of the stapes in association with pathologic conditions of the malleus or incus. The malleus grip procedure was performed on 220 ears, and follow-up studies are available on 203. Mild to profound sensorineural hearing losses occurred in 16 (8.37%). The remaining 187, on the first postoperative test, had an average air-bone gap of 14 dB, and subsequent examinations on 100 of them showed no significant change with the passage of time. The procedure is technically more difficult than stapes surgery for otosclerosis, and success is highly dependent upon selection of appropriate cases and meticulous implantation of the prosthesis.

Sacculo-collic response in otosclerosis and following successful stapes surgery

2007 ◽  
Vol 122 (4) ◽  
pp. 347-350 ◽  
Author(s):  
E Stapleton ◽  
R Mills ◽  
J C Tham
Keyword(s):  
Hearing Loss ◽  
Pressure Wave ◽  
Conductive Hearing Loss ◽  
Short Latency ◽  
Stapes Surgery ◽  
Myogenic Response ◽  
Stapes Fixation ◽  
Stapes Footplate ◽  
Inferior Vestibular Nerve ◽  
Conductive Hearing

AbstractIntroduction:The sacculo-collic reflex is believed to be a short latency, otolith-mediated myogenic response to sound. With the application of air-conducted sound, one would expect an absent response in stapes fixation, as a fixed stapes footplate will not transmit a pressure wave to the saccule.Methods:Fifty patients (70 stapes surgery ears, 26 otosclerotic ears and four normal ears) and 40 controls underwent repeated sacculo-collic tests.Results:The results support the proposed mechanism for the sacculo-collic response. The study also suggests that, whilst stapedotomy piston prostheses are effective in the reversal of conductive hearing loss, they produce an insufficient pressure wave to elicit a myogenic response to sound.Conclusion:The sacculo-collic test could be a useful tool for screening otolith function and inferior vestibular nerve integrity, but further work is needed to determine the effect of stapes surgery on saccular function.

scholarly journals Impact of surgeons’ experience and the single-shot perioperative antibiotic prophylaxis on outcome in stapedotomy

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247451
Author(s):  
Faris F. Brkic ◽  
Boban M. Erovic ◽  
Arina Onoprienko ◽  
Stefan Janik ◽  
Dominik Riss ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Antibiotic Prophylaxis ◽  
Conductive Hearing Loss ◽  
Stapes Surgery ◽  
Single Shot ◽  
Surgical Performance ◽  
Tertiary Referral Center ◽  
Perioperative Antibiotic Prophylaxis ◽  
Large Patient ◽  
Conductive Hearing

Background The aim of this study was to evaluate whether surgeons´ experience and perioperative single-shot antibiotic prophylaxis affect outcome of patients undergoing stapes surgery. Patients and methods We retrospectively evaluated audiological outcomes and postoperative complications of 538 consecutive patients who underwent stapes surgery at a single tertiary referral center between 1990 and 2017. Effects of different clinical variables, including single-shot antibiotic prophylaxis and surgeons’ experience on outcome were assessed. Results 538 patients underwent 667 stapedotomies and postoperative complication rate was 7.5% (n = 50). Air conduction and air-bone gap closure improved significantly after surgery (14.2 ± 14.8 dB, p = 0.001; 14.5 ± 12.8 dB, p = 0.001). Multivariate analysis revealed that 6 years or less of surgical experience was independently associated with a higher incidence of persisting or recurrent conductive hearing loss (p = 0.033, OR 5.13) but perioperative application of antibiotics had no significant effect on outcome. Conclusion First, clinical outcome regarding persisting or recurrent conductive hearing loss caused by incus necrosis and prosthesis luxation is linked to surgical performance. This underlines the need for a meticulous training and supervision of less experienced surgeons performing stapes surgery. Second, our results do not support the need for perioperative antibiotic prophylaxis in stapes surgery. Potential standard limitations of retrospective cohort studies (selection bias, confusion bias etc.) could play a role in interpreting our results. However, the probability for these limitations is minimized due to the large patient sample.

scholarly journals The Use of Lasers in Stapes Surgery

2020 ◽  
Vol 100 (1_suppl) ◽  
pp. 73S-76S
Author(s):  
Rishi Srivastava ◽  
Waisum Cho ◽  
Neil Fergie
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Conductive Hearing Loss ◽  
Disease Process ◽  
Stapes Surgery ◽  
Yttrium Aluminium Garnet ◽  
Ktp Laser ◽  
Thulium Laser ◽  
Increased Risk ◽  
Conductive Hearing

Objectives: Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the conductive hearing loss caused by otosclerosis consists of either rehabilitation with hearing aids or performing surgery. Given the risks of hearing impairment and vertigo associated with the surgery, there has been a desire to advance the practice to minimize the complications. The so-called “non-contact” or “no touch” techniques with the use of various lasers are in current practice. This review article will cover the surgical aspects, the theory behind laser and the various types used in stapes surgery. It will also review the evidence of laser versus conventional stapes surgery and the comparison of different laser types. Methods: A literature search up to December 2019 was performed using Pubmed and a nonsystematic review of appropriate articles was undertaken. Keywords used were stapes, surgery, laser, stapedectomy, and stapedotomy. Results: Overall, there is no evidence to say laser fenestration is better than conventional fenestration techniques; however, with the micro drill, there is an increased risk of footplate fracture and sensorineural hearing loss. There is an increased risk of tinnitus with the laser compared to conventional techniques. Studies have favored the CO2 laser over potassium titanyl phosphate (KTP) and erbium-doped yttrium aluminium garnet (Erbium-YAG) lasers for postoperative closure of the air-bone gap; and KTP laser has less thermal, mechanical, and sound effects compared with the thulium and carbon dioxide (CO2) lasers. There is an increased risk if inner ear complications with the thulium laser. Conclusions: It can be deduced that theoretically and practically, the thulium laser is less safe compared to the KTP and CO2 lasers. The choice of laser used depends on the surgeon’s preference, as well as availability, cost, side effects profile, as well as ease of use.

Laser stapedotomy

1999 ◽  
Vol 113 (5) ◽  
pp. 413-416 ◽  
Author(s):  
Yousef K. Shabana ◽  
Hassan Allam ◽  
C. Brahe Pedersen
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Inner Ear ◽  
Conductive Hearing Loss ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Sensorineural Hearing ◽  
Hearing Results ◽  
The Difference ◽  
Conductive Hearing

AbstractThirty-four ears with conductive hearing loss due to otosclerosis were operated upon using the laser stapedotomy technique. Audiological results were compared with the results of 316 non-laser stapedotomies. The post-operative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller with the laser stapedotomy group. Also, the bone conduction showed significant improvement with the use of laser.Significant sensorineural hearing loss was not found in any of the laser-treated patients. According to our results, we concluded that laser is of benefit in stapes surgery for improving the hearing results and minimizing the inner ear trauma.

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