scholarly journals Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis

2021 ◽  
pp. 014556132110230
Author(s):  
Katarzyna Job ◽  
Agnieszka Wiatr ◽  
Maciej Wiatr
Keyword(s):  
Inner Ear ◽  
Bone Conduction ◽  
Surgical Techniques ◽  
Negative Influence ◽  
Statistical Correlation ◽  
Stapes Surgery ◽  
Hearing Improvement ◽  
Bony Labyrinth ◽  
Postoperative Vertigo ◽  
Hearing Outcomes

Objective: During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis. Methods: The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed. Results: A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy. Conclusions: A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air–bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.

Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation

2021 ◽  
pp. 019459982199066
Author(s):  
Sandra Ho ◽  
Prayag Patel ◽  
Daniel Ballard ◽  
Richard Rosenfeld ◽  
Sujana Chandrasekhar
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Stapes Surgery ◽  
Chorda Tympani Nerve ◽  
Stapes Fixation ◽  
Operative Outcomes ◽  
Significant Difference ◽  
The Mean ◽  
Postoperative Vertigo ◽  
Hearing Outcomes

Objective To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources PubMed, Embase, and Web of Science. Review Methods An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.

A comparison between endoscopic and microscopic approaches for stapes surgery: a systematic review

2020 ◽  
Vol 134 (5) ◽  
pp. 398-403 ◽  
Author(s):  
H F Pauna ◽  
R C Pereira ◽  
R C Monsanto ◽  
M S A Amaral ◽  
M A Hyppolito
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Web Of Science ◽  
Surgical Techniques ◽  
Stapes Surgery ◽  
Less Invasive Surgery ◽  
Microscopic Approach ◽  
Microscopic Surgery ◽  
Hearing Outcomes ◽  
Microscopic Techniques

AbstractObjectivesTo evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery.MethodsSystematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results.ResultsFourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques.ConclusionStudies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.

Erbium: Yttrium-Aluminum-Garnet Laser Application in Stapedotomy

2005 ◽  
Vol 133 (6) ◽  
pp. 923-928 ◽  
Author(s):  
Jacopo Galli ◽  
Claudio Parrilla ◽  
Antonella Fiorita ◽  
Maria Raffaella Marchese ◽  
Gaetano Paludetti
Keyword(s):  
Inner Ear ◽  
Yttrium Aluminum Garnet ◽  
Er:Yag Laser ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Clinical Safety ◽  
Erbium Laser ◽  
Significant Difference ◽  
Yttrium Aluminum ◽  
Student’S T

OBJECTIVE: To assess clinical safety and efficacy of the erbium: yttrium-aluminum-garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear. STUDY DESIGN: Retrospective study. MATERIAL AND METHODS: A microscope-integrated Er: YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure-tone bone-conduction threshold audiogram was obtained. RESULTS: No statistically significant differences were found by Student's t test over all measured frequencies between pre- and postoperative bone-conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone-conduction thresholds. CONCLUSIONS: The results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser. EBM RATING: B-3

scholarly journals Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

2015 ◽  
Vol 20 (01) ◽  
pp. 039-042 ◽  
Author(s):  
José Souza ◽  
Ricardo Bento ◽  
Larissa Pereira ◽  
Liliane Ikari ◽  
Stephanie Souza ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Functional Outcomes ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Educational Institutions ◽  
Teaching Institution ◽  
Bilateral Surgery ◽  
Sound Amplification ◽  
Hearing Outcomes ◽  
Residual Air

Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air–bone gap <10 dB, and 196 (93.3%) had a residual air–bone gap ≤15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.

scholarly journals Stapes Surgery in Patients with a Small Air-Bone Gap

2018 ◽  
Vol 97 (7) ◽  
pp. 198-212 ◽  
Author(s):  
Jeremy Lavy ◽  
Fiona McClenaghan
Keyword(s):  
Outcome Measure ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Primary Outcome Measure ◽  
Stapes Surgery ◽  
Secondary Outcome ◽  
Ktp Laser ◽  
Secondary Outcome Measure ◽  
Tertiary Center ◽  
Hearing Outcomes

The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery were identified from a database of all stapes surgeries performed in a tertiary center over 15 years. A total of 254 ears met the inclusion criteria. The primary outcome measure was the degree of closure of the preoperative ABG. A secondary outcome measure was improvement in bone-conduction thresholds at 4 kHz. All patients underwent stapes surgery under local anesthesia. Ossicular reconstruction was achieved using a SMart 360 nitinol fluoroplastic piston (Gyrus ACMI, Inc.; South-borough, Mass.), and complete posterior crurotomy was performed with a KTP laser. Hearing was assessed with clinical voice testing immediately postoperatively and with pure-tone audiometry at 6 weeks postoperatively. A total of 248 ears (97.6%) demonstrated ABG closure to <10 dB. Bone-conduction thresholds showed an increase in 114 (44.9%), no change 74 (29.1%), and a decrease in 66 (26.0%). There is a slight increase in the risk of stapes mobilization in ears with a small ABG when compared to those with larger ABGs; however, this can be overcome by using a laser-assisted technique in combination with good surgical experience. The benefit in terms of hearing aid avoidance and the restoration of symmetrical hearing is both achievable and significant for the patient.

Stapes fixation surgery: stapedectomy versus stapedotomy

2010 ◽  
Vol 4 (3) ◽  
pp. 429-434 ◽  
Author(s):  
Taweekiat Thamjarayakul ◽  
Pakpoom Supiyaphun ◽  
Kornkiat Snidvongs
Keyword(s):  
Success Rate ◽  
Pure Tone ◽  
Bone Conduction ◽  
Surgical Techniques ◽  
Speech Discrimination ◽  
Stapes Fixation ◽  
Pure Tone Average ◽  
Window Opening ◽  
Hearing Outcomes ◽  
Air Conduction

Abstract Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest.

Predictive Effect of Bone Conduction Pattern on Hearing Outcomes of Stapes Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Scott B. Shapiro ◽  
Meghan Grojean ◽  
Michael Hong ◽  
Noga Lipschitz ◽  
Joseph T. Breen ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Stapes Surgery ◽  
Hearing Outcomes ◽  
Predictive Effect

Revision Stapes Surgery: Hearing Symptoms and Associations With Intraoperative Findings and Outcomes

2021 ◽  
pp. 019459982110620
Author(s):  
Alexander L. Luryi ◽  
Amy Schettino ◽  
Elias M. Michaelides ◽  
Seilesh Babu ◽  
Dennis I. Bojrab ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Bone Conduction ◽  
Scar Tissue ◽  
Primary Outcome Measure ◽  
Stapes Surgery ◽  
Initial Surgery ◽  
The Mean ◽  
Revision Stapes Surgery ◽  
Hearing Outcomes ◽  
Conductive Hearing

Objective Stapes surgery for otosclerosis occasionally requires revision due to recurrent or persistent conductive hearing loss (CHL). This study examines outcomes after revision stapes surgery. Study Design Retrospective review. Setting Single tertiary neurotology center. Methods Patients undergoing revision stapes surgery for otosclerosis from 2008 to 2017 were reviewed. Postoperative air-bone gaps (ABGs) were the primary outcome measure. Results During the study period, 150 patients underwent revision stapes surgery. One hundred patients (67%) had gradually progressive recurrent CHL; 16 (11%), sudden recurrent CHL; 13 (9%), persistent CHL; and 21 (14%), no CHL. For 129 patients with CHL, the mean ABG improved from 23.7 to 9.3 dB ( P < .0005). The most common intraoperative findings for these patients were prosthesis displacement with incus necrosis (38%) or without it (43%), normal anatomy with seemingly good prosthesis placement (6%), and abundant scar tissue (6%). Patients with recurrent hearing loss achieved lower mean ABGs than patients with persistent hearing loss (8.8 vs 13.2 dB, P = .02). There were no associations between onset pattern of CHL or intraoperative findings and hearing outcomes ( P > .05). Four patients (2.7%) developed sensorineural hearing loss after revision, defined as an increase in bone conduction pure tone average ≥15 dB, all of whom had previous replacement of a malpositioned prosthesis. Conclusions Revision stapes surgery confers significant improvement in hearing for patients with persistent and recurrent CHL, although patients with persistent CHL after initial surgery see less improvement with revision.

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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