Revision Stapes Surgery: A Critical Evaluation

1994 ◽  
Vol 111 (4) ◽  
pp. 473-477 ◽  
Author(s):  
Yasar Cokkeser ◽  
Maged Naguib ◽  
Miguel Aristegui ◽  
Essam Saleh ◽  
Mauro Landolfi ◽  
...  
Keyword(s):  
Fibrous Tissue ◽  
Critical Evaluation ◽  
Ossicular Chain ◽  
Oval Window ◽  
Tissue Reaction ◽  
Stapes Surgery ◽  
Surgical Trauma ◽  
Postoperative Results ◽  
Revision Stapes Surgery ◽  
Causes Of Failure

Fifty-six revision stapes surgeries performed during the last 9 years were evaluated retrospectively for their preoperative symptoms, intraoperative findings, and postoperative results according to the causes of failure, at the Gruppo Otologico, Piacenza, Italy. The most frequent causes of failure were found to be prosthetic misalignments, a reaction to the surgical trauma in the form of excess fibrous tissue reaction or new bony regrowth at the oval window, and ossicular chain problems. The location of the pathology was found to be an important factor in the outcome. Sixty percent of cases resulted in 0- to 20-dB air-bone gap. The causes of these failures, management, and their prevention during primary surgeries are also discussed.

Long-term results of revision stapes surgery

1992 ◽  
Vol 106 (11) ◽  
pp. 971-973 ◽  
Author(s):  
Eero Vartiainen ◽  
Juhani Nuutinen ◽  
Jukka Virtaniemi
Keyword(s):  
Revision Surgery ◽  
Oval Window ◽  
Stapes Surgery ◽  
Long Term Results ◽  
Surgical Trauma ◽  
Hearing Results ◽  
The Mean ◽  
Revision Stapes Surgery

AbstractResults of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

Revision Stapes Surgery: The Malleus to Oval Window Wire-Piston Technique

2003 ◽  
Vol 113 (9) ◽  
pp. 1520-1524 ◽  
Author(s):  
Darius Kohan ◽  
Alexander Sorin
Keyword(s):  
Oval Window ◽  
Stapes Surgery ◽  
Revision Stapes Surgery

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

2016 ◽  
Vol 130 (12) ◽  
pp. 1110-1114 ◽  
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.

Systematic review of the use of bone cement in ossicular chain reconstruction and revision stapes surgery

2014 ◽  
Vol 125 (1) ◽  
pp. 227-233 ◽  
Author(s):  
Inge Wegner ◽  
Jelle W.G. van den Berg ◽  
Adriana L. Smit ◽  
Wilko Grolman
Keyword(s):  
Systematic Review ◽  
Bone Cement ◽  
Ossicular Chain ◽  
Stapes Surgery ◽  
Ossicular Chain Reconstruction ◽  
Revision Stapes Surgery

scholarly journals Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases

2021 ◽  
pp. 014556132198914
Author(s):  
Makoto Hosoya ◽  
Masato Fujioka ◽  
Kaoru Ogawa
Keyword(s):  
Facial Nerve Palsy ◽  
Case Series ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
Stapes Surgery ◽  
Chorda Tympani ◽  
Postoperative Results ◽  
Ear Surgery ◽  
Intraoperative Complication ◽  
Membrane Perforation

Objectives: Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis. Methods: We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications. Results: The average postoperative air–bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed. Conclusions: The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.

Transmission of heat to the vestibule during revision stapes surgery using a KTP laser: an in vitro study

2003 ◽  
Vol 117 (5) ◽  
pp. 349-352 ◽  
Author(s):  
Marcin Szymanski ◽  
Robert Mills ◽  
Eric Abel
Keyword(s):  
Stainless Steel ◽  
Soft Tissue ◽  
Vein Graft ◽  
Oval Window ◽  
Stapes Surgery ◽  
Maximum Temperature ◽  
Ktp Laser ◽  
Revision Stapes Surgery

The transmission of heat to the vestibule during revision stapes surgery with a piston in situ has been studied using a KTP laser in an in vitro model. A type K thermocouple was placed around the medial of each piston tested in a ‘vestibule’ filled with saline. The effect of laser hits on fluoroplastic, fluoroplastic-wire and stainless steel stapes prostheses was investigated. The effect of adding blood to the operative field, of introducing a vein graft to seal the stapedotomy and of vaporizing soft tissue in the oval window were also examined. Greater temperature rises occurred with stainless steel than with the other piston types and smaller rises occurred when there was a vein graft in situ. The maximum temperature rise recorded was 2.6°C. We conclude that the use of the KTP laser to clear soft tissue from the oval window is safe when operated at the power levels recommended by the manufacturer.

Failures in Stapedotomy for Otosclerosis

2009 ◽  
Vol 141 (3) ◽  
pp. 395-400 ◽  
Author(s):  
Gregorio G. Babighian ◽  
Silviu Albu
Keyword(s):  
Hearing Loss ◽  
Case Series ◽  
Oval Window ◽  
Surgical Trauma ◽  
Success Rates ◽  
Tertiary Referral ◽  
Hearing Results ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Causes Of Failure

OBJECTIVE: To review the results of 78 revision stapedotomies, determining the causes of failure and the predictors of surgical success. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Seventy-eight operations were performed in a tertiary referral center on 72 patients between 1995 and 2005. Indication for surgery was recurrent or persistent conductive hearing loss. RESULTS: The most common causes of failure were prosthesis displacement, incus necrosis, and oval window fibrosis. Postoperative air-bone gap was closed to within 10 dB in 54 percent of cases, and mean postoperative air-bone gap was 13.6 dB. Over-closure occurred in five percent of cases, sensorineural hearing loss in six percent of cases, and we had one postoperative dead ear. Success rates were higher in cases presenting prosthesis or ossicular malfunction than in cases with oval window problems. Hearing results did not differ if the prosthesis was crimped to either the malleus or the remnant of the long incudal process. Outcomes were similar for local or general anesthesia, and the nitinol piston did not significantly improve the hearing results. CONCLUSION: Revision stapedotomy is less successful than primary procedure. Lessening the surgical trauma provides the most favorable results.

scholarly journals Petrous apex cholesterol granuloma: pictorial review of radiological considerations in diagnosis and surgical histopathology

2013 ◽  
Vol 127 (4) ◽  
pp. 339-348 ◽  
Author(s):  
M Hoa ◽  
J W House ◽  
F H Linthicum ◽  
J L Go
Keyword(s):  
Differential Diagnosis ◽  
Surgical Management ◽  
Fibrous Tissue ◽  
Tissue Reaction ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Surgical Drainage ◽  
Radiological Features ◽  
Pictorial Review ◽  
Appropriate Treatment

AbstractBackground:Petrous apex cholesterol granulomas are expansile, cystic lesions containing cholesterol crystals surrounded by foreign body giant cells, fibrous tissue reaction and chronic inflammation. Appropriate treatment relies on an accurate radiological diagnosis and an understanding of the distinguishing radiological features of relevant entities in the differential diagnosis of this condition.Methods:Firstly, this paper presents a pictorial review of the relevant radiological features of petrous apex cholesterol granuloma, and highlights unique features relevant to the differential diagnosis. Secondly, it reviews the histopathological and radiological findings associated with surgical drainage of these lesions.Results:Radiological features relevant to the differential diagnosis of petrous apex cholesterol granuloma are reviewed, together with radiological and histopathological features relevant to surgical management. Following surgical management, histopathological and radiological evidence demonstrates that the patency of the surgical drainage pathway is maintained.Conclusion:Accurate diagnosis of petrous apex cholesterol granuloma is essential in order to instigate appropriate treatment. Placement of a stent in the drainage pathway may help to maintain patency and decrease the likelihood of symptomatic recurrence.

Experimental Stapedectomy

1977 ◽  
Vol 86 (4_suppl) ◽  
pp. 1-39 ◽  
Author(s):  
Gary K. Thomas
Keyword(s):  
Bone Formation ◽  
Otitis Media ◽  
Endolymphatic Hydrops ◽  
Blood Clot ◽  
Fibrous Tissue ◽  
Oval Window ◽  
New Bone Formation ◽  
Temporalis Fascia ◽  
In Series ◽  
Temporal Bones

This animal experimental study (144 cats) was designed to allow observation of the healing processes at the oval window following stapedectomy during the first two postoperative weeks. The first 61 animals (Series I) had no oval window cover except for a blood clot which might form spontaneously. The second 64 animals (Series II) had Gelfoam® as a cover to the oval window following stapedectomy. A third series of 19 animals had temporalis fascia used as the oval window cover, and these ears were studied histologically for up to nine weeks. The unoperated ear acted as a control for the operated ear in all animals and after the animals were killed, both temporal bones were decalcified, imbedded in celloidin, serially sectioned at 20μ, and every tenth section stained and mounted for histologic study. It was observed that oval window closure was effected by endosteal, periosteal, and fibrous tissue proliferation from the traumatized tissues about the oval window fenestra, and that this process was facilitated by the presence of some type of scaffolding material such as a blood clot or Gelfoam®. Temporalis fascia placed in the oval window was observed to be rapidly incorporated into a much thicker oval window neomembrane and to seal the fenestra promptly. Partial removal of the footplate also facilitated more rapid closure of the smaller oval window fenestra, but fibrous tissue and new bone formation was noted to form about bony fragments still attached at the oval window level. Free bony fragments within the vestibule were not observed to stimulate new bone formation. Suppuration was observed most frequently in Series I (no oval window cover), with 67.8% of these animals having some degree of otitis media. In Series II (Gelfoam® cover) 20.6% had otitis media, and in Series III (temporalis fascia) 21% had middle ear infection. Suppuration markedly impaired but did not completely prevent the oval window reparative processes. Animals having some type of oval window cover were noted to have a lesser incidence of suppurative labyrinthine involvement when otitis media was present. Other labyrinthine complications were observed, including endolymphatic hydrops, Wittmaack's hypotonic atrophy, as well as RBC, fibrin, and albuminous precipitates in the labyrinth. Hypotonic atrophy was observed in a high incidence of animals having rupture of one or more endolymphatic structures, suggesting a mechanical mechanism as one possible explanation for this condition. Hypotonic atrophy may represent the end-stage (collapse) in the fluctuant endolymphatic ballooning of hydrops which is seen when saccular or Reissner's membrane ruptures have occurred.

Sign in / Sign up

Export Citation Format

Share Document