To compare the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air conduction gain and Air Bone Gap closure in LASER Stapedotomy – A retrospective study

Aim: To determine the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air Conduction Threshold (ACT) gain and Air Bone Gap (ABG) closure in patients undergoing LASER Stapedotomy. Methods: This retrospective study was conducted at the department of ENT and Head and Neck Surgery, AIIMS Patna. 40 patients underwent LASER stapedotomy. Both Teflon (0.4mm and 0.6mm D, Grace Medical Devices) and Titanium (0.4mm D, Kurz Medical Devices) pistons were inserted randomly. Crimping of titanium Kurz piston was not required due to its unique design which fits on to the incus long process like a clip whereas all the Teflon pistons required crimping.Titanium (Kurz Medical Devices) pistons are costlier in comparison to Teflon (Grace Medical Devices) pistons. Preoperative and 3 monthly postoperative Pure Tone Audiograms (PTA) wereobtained. ACT (Air conduction threshold) gain and ABG (Air Bone Gap) closure were measured.Data was analyzed with IBM SPSS Statistics software Version 20. Descriptive analysis,paired and unpaired t-tests were applied. P-value of <0.05 at 95% confidence levels was considered statistically significant. Results: 40 patients (M: F: 3:7) underwent LASER stapedotomy.Titanium piston was utilized in 11and Teflon in 29 patients. Patients with titanium piston experienced a mean ACT gain of 21.51±05.42dBand mean ABG closure of 12.27±05.18 dB. Those with Teflon piston gained a meanACT gain of 18.54±04.43 dB and mean ABG closure of11.96±06.12 dB.Both groups experienced statistically significant hearing gain (p <0.05).Both groups were however comparable and the difference between these parameters was statistically insignificant (p>0.05).Conclusion: Both titanium and Teflon pistons are equally efficacious in improving postoperative hearing gain in LASER stapedotomy patients in terms of ACT gain and ABG closure. Titanium Kurz pistons do not require crimping making it easier to use in comparison to the Teflon pistons which needs to be crimped every time though cost may be a limiting factor in the usage of Titanium pistons.Both types of pistons can be satisfactorily employed in this surgical procedure if we consider the hearing gain post operatively. Study design: A retrospective observational study Keywords: Otosclerosis, Teflon, Titanium, Air Conduction Threshold (ACT), Air Bone Gap (ABG) closure

Comparative study showing relevance of prosthesis diameter and hearing outcome in stapes surgery

<p class="abstract"><strong>Background:</strong> Otosclerosis presents as conductive hearing loss, stapedotomy is the treatment for otosclerosis, and different sizes of piston diameter are available for the procedure. Aims and objectives were to study and compare hearing improvement between the 0.4 and 0.6 mm sizes of teflon piston in stapedotomy.</p><p class="abstract"><strong>Methods:</strong> It was a prospective randomized controlled trial. Patients fulfilling inclusion criteria were subjected for small fenestra stapedotomy. Patients were divided into two groups after randomization into group A (with 0.4 mm piston diameter) and group B (with 0.6 mm piston diameter). The hearing outcome with standard audiological assessment was performed at one month and six months postoperatively. </p><p class="abstract"><strong>Results:</strong> Comparison of 1 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.699). Comparison of 6 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.54).</p><p class="abstract"><strong>Conclusions:</strong> There was no significant difference in hearing improvement among the individual methods (piston size 0.4 and 0.6) with each other both in 1 month post-operative and 6 month post-operative follow up. Hence, we conclude that there is no relevance of different diameter of teflon piston prosthesis (0.4 mm versus 0.6 mm) as far as hearing outcome is concerned.</p>

Congenital stapes footplate fixation associated with duplication of lobule

We report the case of an 18-year-old male patient who presented to us with unilateral conductive hearing loss with duplication of the lobule. An exploratory tympanotomy revealed stapes footplate fixation. A stapedotomy with insertion of a Teflon piston was performed with improvement in his hearing. We believe this is the first reported case of such an abnormality.

Stapedectomy with Vein Graft and Teflon Piston

Educational objectives: To know how to recognize otosclerosis, which patients to operate on, and how toper-form a stapedectomy.

Posterior crus stapedectomy

The results of stapedectomy were compared between 162 otosclerotic ears operated on using the posterior crus technique and 182 otosclerotic ears undergoing Teflon piston stapedectomy. The large fenestra technique with fascia seal to the oval window was used in all cases. Mean follow-up period was 9.6 years. Neither short- nor long-term hearing results showed any significant differences between the two surgical technique groups. Complications of surgery were more common in patients undergoing Teflon piston stapedectomy. On the other hand, a re-operation for recurring conductive deafness was performed significantly more often in patients undergoing posterior crus stapedectomy.

Hearing Gain after Stapedotomy, Partial Platinectomy, or Total Stapedectomy for Otosclerosis

The differences in hearing gain 1 year after stapedectomy, partial platinectomy, or total stapedectomy for otosclerosis were studied separately at 0.5, 1, 2, 4, and 8 kHz with the data available from 311 consecutive primary operations performed between 1980 and 1982 in the University of Nijmegen Department of Otorhinolaryngology. Three groups of patients were matched for age, sex, clinical type of otosclerosis, and type of 0.6-mm all-Teflon piston. The hearing gain for air conduction was significantly better by an average of 7.4 dB for all frequencies combined after either stapedotomy or partial platinectomy compared to total stapedectomy.