Stapes fixation surgery: stapedectomy versus stapedotomy

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.

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Assessing ototoxicity and patients’ satisfaction of topical local anaesthesia in myringotomy and ventilation tube insertion

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000288 ◽

2019 ◽

Vol 133 (4) ◽

pp. 285-288

Author(s):

S Marzouk ◽

A Al-lami ◽

R Sykes ◽

C Neumann ◽

I J Nixon

Keyword(s):

Local Anaesthesia ◽

Pure Tone ◽

Animal Studies ◽

Bone Conduction ◽

Sensorineural Hearing ◽

Ventilation Tube ◽

Tube Insertion ◽

Pure Tone Average ◽

Patients Satisfaction ◽

Hearing Outcomes

AbstractObjectivesAnimal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients’ satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia.MethodsTwenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure.ResultsMedian patient age was 55 years (range, 27–88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of −1.22 dB, 95 per cent confidence interval of −5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB.ConclusionThe results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.

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Tympanoscopy to increase the accuracy of diagnosis in conductive hearing loss

The Journal of Laryngology & Otology ◽

10.1017/s0022215100140174 ◽

1998 ◽

Vol 112 (2) ◽

pp. 154-157 ◽

Cited By ~ 9

Author(s):

Tapio S. Karhuketo ◽

Heikki J. Puhakka ◽

Pekka J. Laippala

Keyword(s):

Decision Making ◽

Hearing Loss ◽

Pure Tone ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Speech Discrimination ◽

Bone Conduction Threshold ◽

Pure Tone Average ◽

Stapedial Reflex ◽

Conductive Hearing

AbstractThe diagnosis of conductive hearing loss is usually based on audiological methods and radiology. The aim of our study was to show that there is a useful additive method to clarify the findings of diseases with conductive hearing loss.Patients (151 ears) with conductive hearing loss were examined using several methods: otomicroscopy, air- and bone-conduction threshold, pure tone average, speech threshold, speech discrimination, tympanometry and stapedial reflex and tympanoscopy.The management of the patients changed in 17 per cent of cases due to tympanoscopy. In a group with normal tympanic membrane the movement of the stapes during endoscopy was compared to stapedial reflex. Stiff stapes were found more often than an abnormal stapedial reflex.Middle ear endoscopy can increase the accuracy of diagnosis of conductive hearing loss thus enhancing decision making in the case of the patient.

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The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210171 ◽

2021 ◽

Vol 7 (2) ◽

pp. 358

Author(s):

Apoorva Kumar Pandey ◽

Ajaz U. Haq ◽

Sharad Hernot ◽

Madhuri Kaintura ◽

Aparna Bhardwaj ◽

...

Keyword(s):

Success Rate ◽

Pure Tone ◽

Randomized Study ◽

Chronic Otitis Media ◽

Functional Results ◽

Pure Tone Average ◽

Cartilage Tympanoplasty ◽

The Difference ◽

Graft Success ◽

Hearing Outcomes

Background: The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.Methods: This prospective non-controlled, non-randomized study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups: revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears . Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p<0.05 was considered statistically significant for the hearing outcomes. Results: Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p<0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.Conclusions: This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.

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

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418806922 ◽

2018 ◽

Vol 128 (1) ◽

pp. 50-55 ◽

Cited By ~ 1

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.

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Office-Based Stapes Surgery

Otolaryngology ◽

10.1177/0194599819877652 ◽

2019 ◽

Vol 161 (6) ◽

pp. 1018-1026 ◽

Cited By ~ 1

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.

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Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2021.00360 ◽

2021 ◽

Vol 64 (10) ◽

pp. 711-719

Author(s):

Min Kyu Lee ◽

Tae Min Kim ◽

Sung Jin Lim ◽

Dong Heun Park ◽

Yoon Chan Rah ◽

...

Keyword(s):

Retrospective Study ◽

Success Rate ◽

Tympanic Membrane ◽

Surgical Outcomes ◽

Pure Tone ◽

Current Knowledge ◽

Tympanic Membrane Perforations ◽

The Mean ◽

Hearing Outcomes ◽

Paired T Test

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, p=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

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Hearing Status after Stapedotomy in Otosclerotic Patients

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i2.45205 ◽

2020 ◽

Vol 25 (2) ◽

pp. 85-93

Author(s):

Ahmed Tariq ◽

Mostafizur Rahman ◽

Delwar Hossain ◽

Sheikh Hasanur Rahman

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Surgical Techniques ◽

Neck Surgery ◽

Speech Discrimination ◽

College Hospital ◽

Medical College ◽

Medical University ◽

Conductive Hearing

Otosclerosis is the most frequent cause of conductive hearing loss in patients with intact tympanic membrane. It can be treated by surgery with various techniques. Because of limited manipulation and comparably similar results, stapedotomy at present is preferred over other surgical techniques by most surgeons. Here we present the operative results of 35 otosclerotic patients who underwent stapedotomy between January 2009 - October 2010 in the department of Otolaryngology- Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Shahid Suhrawardhy medical college & hospital, Dhaka. The aim of this study was to evaluate the hearing results following stapedotomy in otosclerosis surgery. The average air-bone gap of patients improved significantly to 21.74 dB after operation. Other hearing parameters of patients (including air conduction, bone conduction, speech discrimination score, and tinnitus) also improved. No patient experienced persistent vertigo after the operation and pre operative tinnitus resolved in 12 out of 22 patients. Stapedotomy is a safe and effective modality for improving conductive hearing loss in otosclerotic patients. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 85-93

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Auditory Functional Age

Aging and Human Development ◽

10.2190/nk8u-jgtp-atay-0hnm ◽

1972 ◽

Vol 3 (2) ◽

pp. 183-187 ◽

Cited By ~ 5

Author(s):

Benjamin Bell

Keyword(s):

Bone Conduction ◽

Low Frequency ◽

Speech Discrimination ◽

Hearing Ability ◽

Speech Reception ◽

Aging Study ◽

Normative Aging ◽

Bone Conduction Hearing ◽

Speech Reception Thresholds ◽

Air Conduction

In the audiologic research of the Boston VA Normative Aging Study, an auditory age measure has been developed to represent the extent to which an individual is older or younger than his age peers in terms of his hearing ability. Sixteen auditory measures were placed in a stepwise regression procedure: air and bone conduction hearing at various frequencies, speech reception thresholds, speech discrimination scores, and two and three frequency averages. With chronological age as criterion, the resulting equation yielded an auditory age calculated from two variables: air conduction at 8,000 cps and speech reception threshold. Because of redundancy among the larger number of measures, these two effectively index the larger number. The two include high and low frequency measures so are sensitive to high frequency loss at older age.

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Significance of Cochlear Dose in the Radiosurgical Treatment of Vestibular Schwannoma

Neurosurgery ◽

10.1227/neu.0000000000000299 ◽

2014 ◽

Vol 74 (5) ◽

pp. 466-474 ◽

Cited By ~ 30

Author(s):

Jeffrey T. Jacob ◽

Matthew L. Carlson ◽

Terry K. Schiefer ◽

Bruce E. Pollock ◽

Colin L. Driscoll ◽

...

Keyword(s):

Computed Tomography ◽

Vestibular Schwannoma ◽

Pure Tone ◽

Interobserver Reliability ◽

Univariate Analysis ◽

Hearing Preservation ◽

Neck Surgery ◽

Tumor Control ◽

Speech Discrimination ◽

Pure Tone Average

Abstract BACKGROUND: Cochlear dose has been identified as a potentially modifiable contributor to hearing loss after stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). OBJECTIVE: To evaluate the association between computed tomography-based volumetric cochlear dose and loss of serviceable hearing after SRS, to assess intraobserver and interobserver reliability when determining modiolar point dose with the use of magnetic resonance imaging and computed tomography, and to discuss the clinical significance of the cochlear dose with regard to radiosurgical planning strategy. METHODS: Patients with serviceable pretreatment hearing who underwent SRS for sporadic VS between the use of Gamma Knife Perfexion were studied. Univariate and multivariate associations with the primary outcome of time to nonserviceable hearing were evaluated. RESULTS: A total of 105 patients underwent SRS for VS during the study period, and 59 (56%) met study criteria and were analyzed. Twenty-one subjects (36%) developed nonserviceable hearing at a mean of 2.2 years after SRS (SD, 1.0 years; median, 2.1 years; range 0.6-3.8 years). On univariate analysis, pretreatment pure tone average, speech discrimination score, American Academy of Otolaryngology-Head and Neck Surgery hearing class, marginal dose, and mean dose to the cochlear volume were statistically significantly associated with time to nonserviceable hearing. However, after adjustment for baseline differences, only pretreatment pure tone average was statistically significantly associated with time to nonserviceable hearing in a multivariable model. CONCLUSION: Cochlear dose is one of many variables associated with hearing preservation after SRS for VS. Until further studies demonstrate durable tumor arrest with reduced dose protocols, routine tumor dose planning should not be modified to limit cochlear dose at the expense of tumor control.

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Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215109992611 ◽

2010 ◽

Vol 124 (5) ◽

pp. 490-494 ◽

Cited By ~ 32

Author(s):

S-E Stangerup ◽

M Tos ◽

J Thomsen ◽

P Caye-Thomasen

Keyword(s):

Vestibular Schwannoma ◽

Predictive Value ◽

High Frequency ◽

Pure Tone ◽

Hearing Level ◽

Speech Discrimination ◽

Resonance Imaging ◽

Hearing Outcome ◽

Hearing Outcomes ◽

Better Than

AbstractAims:This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma.Subjects:Over a 33-year period, 1144 patients with vestibular schwannoma were allocated to ‘wait and scan’ management, with annual magnetic resonance imaging and audiological examination. Two complete pure tone and speech discrimination audiograms were available for 932 patients.Results:The predictive value of initial hearing level better than 10 dB for forecasting hearing outcome after observation increased from 59 per cent at 250 Hz to 94 percent at 4000 Hz. At diagnosis, hearing level of 10 dB or better at 4000 Hz was found in only 18 of the 932 VS ears, while good speech discrimination was found in 159 patients (17 per cent). Of the latter patients, 138 maintained good hearing after observation.Conclusion:In vestibular schwannoma patients, good high frequency hearing and good speech discrimination at diagnosis are useful tools in predicting good hearing after observation.

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