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.

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.

Association Between the Duration of Hearing Loss and Hearing Outcomes in Surgery for Otosclerosis

2020 ◽  
pp. 019459982096472
Author(s):  
Alexander L. Luryi ◽  
Amy Schettino ◽  
Seilesh C. Babu ◽  
Dennis I. Bojrab ◽  
Elias M. Michaelides ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Revision Surgery ◽  
Retrospective Review ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Stapes Surgery ◽  
Complication Rates ◽  
Long Duration ◽  
Hearing Outcomes

Introduction Hearing loss due to otosclerosis is effectively treated with surgery. The association between duration of hearing loss and surgical outcomes is unknown. Study Design Retrospective review. Setting Large otology referral center. Methods Patients undergoing primary stapes surgery for otosclerosis from 2005 to 2017 were evaluated according to their self-reported duration of hearing loss. Closure of the air-bone gap (ABG) was the primary outcome measure. Results A total of 580 stapes operations were included. Sixteen percent of patients reported hearing loss for ≤1 year; 25%, >1 to ≤5 years; 24%, >5 to ≤10 years; 24%, >10 to ≤20 years; and 12%, >20 years, respectively. Average pre- and postoperative ABGs were 26.1 and 9.6 dB ( P < .0005). Patients with longer duration of hearing loss had worse preoperative ABGs ( P < .0005). After surgery, patients with longer duration of hearing loss had a greater reduction in their ABGs ( P < .0005) such that the remaining ABG was not associated with duration of hearing loss ( P > .05). There were no significant associations between the duration of hearing loss and complication rates or the need for revision surgery. Conclusion Otosclerosis is effectively treated with surgery even after a long duration of hearing loss, provided that sensorineural hearing and word recognition are favorable. Although far-advanced otosclerosis has known poorer hearing outcomes after stapes surgery, a long duration of hearing loss is an unreliable surrogate for this.

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.

Outcomes in Revision Stapes Surgery

2021 ◽  
pp. 019459982199147
Author(s):  
Zachary G. Schwam ◽  
Amy Schettino ◽  
Seilesh C. Babu ◽  
Dennis I. Bojrab ◽  
Elias M. Michaelides ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Stapes Surgery ◽  
Observational Research ◽  
Multivariable Logistic Regression Analysis ◽  
Complication Rates ◽  
Single Institution ◽  
Chi Square ◽  
Level Of Evidence ◽  
The Mean ◽  
Revision Stapes Surgery

Objectives To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. Study Design Retrospective cohort study. Setting Large single-institution database. Methods Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. Results Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to ≤20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions ( P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries ( P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 ( P < .001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. Conclusions Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. Level of Evidence: 4 (retrospective observational research).

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.

Surgical treatment in children with otosclerosis and congenital stapes fixation: our experience and outcome

2018 ◽  
Vol 72 (6) ◽  
pp. 1-5
Author(s):  
Pedro Clarós ◽  
Aleksandra Sobolewska
Keyword(s):  
Hearing Loss ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Stapes Surgery ◽  
Stapes Fixation ◽  
Long Term Follow Up ◽  
The Mean ◽  
Conductive Hearing

Aim: To evaluate outcomes of stapes surgery in children with congenital stapes fixation and juvenile otosclerosis. Methods: A retrospective chart review was performed from 1987 to 2013 to identify patients under 18 years old who underwent a stapes surgery. Patients' age, gender, pre- and postoperative audiograms, intraoperative findings including aetiology of stapes fixation, prosthesis type, and complications were analysed. Results: 18 children (6 - 17 years old), all with bilateral conductive hearing loss were identified and 34 stapes surgeries were performed (two patients underwent surgery only on one side). The cause of fixation included juvenile otosclerosis in 88% and congenital stapes fixation in 12%. The mean pre-operative air-bone gap (ABG) was 36,24 dB (SD: 10,86) compared to a postoperative mean ABG of 7,74 (SD: 3,3) (p < 0.000). The profound sensorineural hearing loss was not observed in long-term follow-up. Conclusions: Paediatric stapes surgery has comparable results to stapedectomy in adults regardless of the cause of stapes fixation; however, the better hearing outcome was observed for cases of juvenile otosclerosis rather than congenital stapes fixation.

Long-term Compliance and Satisfaction With Percutaneous Bone Conduction Devices in Patients With Congenital Unilateral Conductive Hearing Loss

2015 ◽  
Vol 36 (5) ◽  
pp. 826-833 ◽  
Author(s):  
Rik C. Nelissen ◽  
Emmanuel A. M. Mylanus ◽  
Cor W. R. J. Cremers ◽  
Myrthe K. S. Hol ◽  
Ad F. M. Snik
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Bone Conduction ◽  
Conductive Hearing

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.

Factors Associated With Hearing Outcomes After Stapedotomy in Taiwanese Patients With Clinical Otosclerosis

2021 ◽  
pp. 014556132110376
Author(s):  
Pei-Hsin Chen ◽  
Kai-Nan Lin ◽  
Hsiu-Yin Lin ◽  
Rui-Bin Yu ◽  
Pi-Yun Liu ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Success Factors ◽  
Bone Conduction ◽  
Hearing Results ◽  
Hearing Sensitivity ◽  
Surgical Success ◽  
Factors Associated ◽  
Male Patients ◽  
Hearing Outcomes ◽  
Stratified Analysis

Objective: To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis. Methods: In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis. Results: Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds ( P < .0001), bone conduction (BC) thresholds ( P = .025), and air-bone gaps (ABGs; P < .0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r = .650, P < .001 and r = .745, P < .001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r = .893, P < .001 and r = .476, P = .014, respectively), and in postoperative and preoperative ABGs (r = .933, P < .001 and r = .626, P < .001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes. Conclusions: We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate.

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