Office-Based Stapes Surgery

2019 ◽  
Vol 161 (6) ◽  
pp. 1018-1026 ◽  
Author(s):  
Béatrice Voizard ◽  
Anastasios Maniakas ◽  
Issam Saliba
Keyword(s):  
Operating Room ◽  
Pure Tone ◽  
Care Center ◽  
Tertiary Care ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Complication Rates ◽  
Pure Tone Average ◽  
Air Conduction

Objective The objective of this study was to provide a proof of concept and to assess the success and safety of stapes surgery for otosclerosis under local anesthesia in an office-based setting (OBS) as compared with a hospital operating room setting (ORS). Study Design Retrospective cohort study. Setting We reviewed all patients who underwent stapes surgery by the same surgeon from October 2014 to January 2017 at our tertiary care center (ORS, n = 36, 52%) and in an OBS (n = 33, 48%). Subjects and Methods The surgical technique was identical in both groups. All patients had a temporal bone computed tomography scan and audiogram within the 6 months prior to surgery. Air-bone gaps (ABGs), bone conduction, and air conduction pure tone average values were calculated. Preoperative results for pure tone average, bone conduction, ABG, and word recognition scores were compared with early (4 months) and late (12 months) follow-up audiograms. Intra- and postoperative complications were compared. Results Both groups were comparable in terms of demographic characteristics and severity of disease. The mean 1-year postoperative ABG was 5.66 dB (95% CI = 4.42-6.90) in the ORS group and 6.30 dB (95% CI = 4.50-8.10) in the OBS group ( P = .55). ABG improved by 24.27 dB (95% CI = 21.40-27.13) in the ORS group and 23.15 dB (95% CI = 18.45-27.85) in the OBS group ( P = .68). Complication rates did not differ, although this study remains underpowered. Conclusions In this small group of patients, the success of stapes surgery performed in an OBS and its complications were comparable to those of an ORS, thus providing an alternative to patients on long operating room waiting lists.

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.

scholarly journals Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas

2009 ◽  
Vol 123 (10) ◽  
pp. 1108-1113 ◽  
Author(s):  
P Homøe ◽  
H C Florian Sørensen ◽  
M Tos
Keyword(s):  
Otitis Media ◽  
Pure Tone ◽  
Chronic Otitis Media ◽  
Ear Surgery ◽  
Suppurative Otitis Media ◽  
Remote Areas ◽  
Pure Tone Average ◽  
One Stage ◽  
Air Conduction

AbstractObjectives:We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas.Materials and methods:The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the ‘take rate’ (i.e. the percentage of total ears with a closed perforation) was evaluated.Results:All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of ≤25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards.Conclusions:The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.

scholarly journals Longitudinal analysis of the audiological phenotype in osteogenesis imperfecta: a follow-up study

2018 ◽  
Vol 132 (8) ◽  
pp. 703-710 ◽  
Author(s):  
S Martens ◽  
I J M Dhooge ◽  
F K R Swinnen
Keyword(s):  
Osteogenesis Imperfecta ◽  
Longitudinal Analysis ◽  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Time Interval ◽  
Pure Tone Average ◽  
Acoustic Admittance

AbstractObjectiveThis prospective study involved a longitudinal analysis of the progression of hearing thresholds in patients with osteogenesis imperfecta.MethodsAudiometric results from 36 osteogenesis imperfecta patients (age range, 6–79 years) were compared between two test times with an average interval of 4 years. Audiometric evaluation included acoustic admittance measurements, acoustic stapedial reflex measurements, pure tone audiometry and otoacoustic emissions testing.ResultsAir conduction pure tone average, corrected for sex and age, and bone conduction pure tone average increased significantly in the study population (p < 0.05 and p < 0.001, respectively). In 14.3 per cent of the evaluated ears, an alteration in type and/or severity of hearing loss was observed.ConclusionAfter an average time interval of four years, significant changes in hearing status occurred in a population of osteogenesis imperfecta patients. These findings highlight the importance of regular audiological follow up in osteogenesis imperfecta patients, including audiometry, and measurements of acoustic admittance, acoustic stapedial reflexes and otoacoustic emissions.

scholarly journals Pilot Study Assessing the Feasibility and Clinical Outcomes of Office-Based Ossiculoplasty

2018 ◽  
Vol 128 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Nael Shoman
Keyword(s):  
Local Anesthesia ◽  
Pure Tone ◽  
Intraoperative Complications ◽  
Bone Conduction ◽  
Tympanic Membrane Perforation ◽  
Office Setting ◽  
Pure Tone Average ◽  
Membrane Perforation ◽  
The Mean ◽  
Air Conduction

Objectives: The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation. Methods: Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection. Results: Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB ( P < .0001). Air-bone gap significantly improved to 17.8 dB ( P < .0001). Conclusions: Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.

Audiological Outcomes of Stapedotomy: Our Experience

2018 ◽  
Vol 5 (2) ◽  
pp. 1-4
Author(s):  
R. Pradhananga ◽  
G. Nair ◽  
R. Sapathkumar ◽  
M. Kameswaran
Keyword(s):  
Clinical Study ◽  
Pure Tone ◽  
Bone Conduction ◽  
Prospective Clinical Study ◽  
Hearing Improvement ◽  
Gap Closure ◽  
Age Range ◽  
Air Conduction

Objective: This study was aimed to sequentially document the patient’s audiological improvement after stapedotomy as measured by pure tone audiometry.Material and Methods: This prospective clinical study was performed in a total of 100 patients (age range: 20 – 63 years), diagnosed with Otosclerosis who underwent Stapedotomy at the Department of Otology, Madras ENT Research Foundation, Chennai between September 2010 to March 2012. Pre-operative and Post-operative audiometric evaluation was done using the same conventional pure tone audiometer with standard calibrations. Post-operative audiometry was sequentially performed at 6 months, 1 year and 2 years. Bone-conduction and air conduction thresholds and the Air-bone gap (ABG), were assessed at each schedule at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively.Result: All patients had significant audiological improvement as measured by their sequential pure tone audiometries. Overall, the frequency specific pre-operative mean average Air-Bone gap was 52.3dB at 500Hz, 36.5dB at 1KHz, 39.3dB at 2KHz, 38.7dB at 4KHz and the frequency specific postoperative mean average Air-Bone Gap closure was achieved by 27.8dB at 500Hz, 29.6dB at 1KHz, 13.6dB at 2KHz, 11.4dB at 4KHz, by the time of 2 years of follow up. A successful closure of AB gap >10dB was achieved in these speech frequencies in 80% of cases. The frequency specific bone-conduction thresholds were unchanged postoperatively. Two patients developed post-operative vertigo, out of which 1 developed SNHL after 3 weeks of surgery.Conclusion: The study confirms that stapedotomy is a safe and successful procedure in the hands of a well trained otologist, providing long-term hearing improvement to patients with otosclerosis.

scholarly journals Stapes Surgery in Far-Advanced Otosclerosis

2021 ◽  
pp. 014556132110130
Author(s):  
Moscillo Luca ◽  
Massimilla Eva Aurora ◽  
Mastella Americo ◽  
Nunziata Michele ◽  
Anna Donadio ◽  
...  
Keyword(s):  
Hearing Aids ◽  
Pure Tone ◽  
Standardized Patients ◽  
Stapes Surgery ◽  
Postoperative Results ◽  
Hearing Results ◽  
Pure Tone Average ◽  
First Choice ◽  
Before And After

Introduction: Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results. Objective: The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy. Materials and Methods: Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy. Results: The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years). Conclusions: The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure.

scholarly journals Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

2021 ◽  
pp. 1-8
Author(s):  
Halil Celik ◽  
Sadettin Burak Acikel ◽  
Fatih Mehmet Akif Ozdemir ◽  
Erhan Aksoy ◽  
Ulkuhan Oztoprak ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Chronic Conditions ◽  
Care Center ◽  
Tertiary Care ◽  
Anxiety Level ◽  
Childhood And Adolescence ◽  
Routine Examination ◽  
Significant Difference ◽  
Anxiety Levels

<b><i>Background and Aim:</i></b> Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. <b><i>Methods:</i></b> The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. <b><i>Results:</i></b> There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. <b><i>Conclusion:</i></b> Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1215-e1224 ◽  
Author(s):  
Soma Saha ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
Chandrasekhar Bal ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Conventional Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Fractional Excretion ◽  
Renal Calculi ◽  
Serum Total Calcium ◽  
Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

scholarly journals Postpartum follow up of gestational diabetes in a Tertiary Care Center

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
C. A. Cabizuca ◽  
P. S. Rocha ◽  
J. V. Marques ◽  
T. F. L. R. Costa ◽  
A. S. N. Santos ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Author(s):  
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav
Keyword(s):  
Variceal Bleeding ◽  
Patency Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
North India ◽  
Related Complication ◽  
Variceal Bleed ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

Sign in / Sign up

Export Citation Format

Share Document