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Otolaryngologic Clinics of North America Apr 2018Over the past several years, with the evolution of genetic and molecular research, several etiologic factors have been implicated in the pathogenesis of otosclerosis.... (Review)
Review
Over the past several years, with the evolution of genetic and molecular research, several etiologic factors have been implicated in the pathogenesis of otosclerosis. Overall, current evidence suggests that otosclerosis is a complex disease with a variety of potential pathways contributing to the development of abnormal bone remodeling in the otic capsule. These pathways involved in the pathogenesis of otosclerosis are influenced by both genetic and environmental factors.
Topics: Bone Remodeling; Ear, Inner; Gene Expression; Genetic Predisposition to Disease; Humans; Measles virus; Osteoprotegerin; Otosclerosis; RANK Ligand; Temporal Bone
PubMed: 29502723
DOI: 10.1016/j.otc.2017.11.002 -
Otolaryngologic Clinics of North America Apr 2018The anatomy of the vestibular organs together with considerations of the middle and inner ear anatomy relevant to stapes surgery is discussed. An archival collection of... (Review)
Review
The anatomy of the vestibular organs together with considerations of the middle and inner ear anatomy relevant to stapes surgery is discussed. An archival collection of macerated and freshly frozen human temporal bones underwent micro-computed tomography (CT) with subsequent volume-rendering. Three-dimensional (3D) reconstructions and the topographic anatomy of the oval window were considered. Micro-CT and 3D rendering revealed the relationship between the otolith organs and the oval window. Anatomic variations were extensive and included the distance between the footplate and the reconstructed macula margins. A "no-go" zone is suggested for the surgeon to avoid injury during stapes surgery.
Topics: Ear Ossicles; Humans; Imaging, Three-Dimensional; Otosclerosis; Stapes Surgery; Temporal Bone; X-Ray Microtomography
PubMed: 29397114
DOI: 10.1016/j.otc.2017.11.013 -
Otolaryngologic Clinics of North America Apr 2018Otosclerosis surgery is performed through a transcanal approach and requires long, thin instruments with submillimetric precision and precise amplitude of motion. The... (Review)
Review
Otosclerosis surgery is performed through a transcanal approach and requires long, thin instruments with submillimetric precision and precise amplitude of motion. The functional outcomes and complications of otosclerosis surgery depend on the experience of the surgeon. Thus, any technological assistance that can enhance the surgeon's dexterity and rapidly reduce the learning curve could yield an even safer surgical procedure. One of the options is to use robotic assistance to achieve this goal. An overview of different robots designed for otosclerosis surgery is presented focusing on the RobOtol system that we have designed as a multitask platform for ear surgery.
Topics: Evidence-Based Medicine; Humans; Learning Curve; Minimally Invasive Surgical Procedures; Otosclerosis; Robotic Surgical Procedures; Stapes Surgery
PubMed: 29502730
DOI: 10.1016/j.otc.2017.11.016 -
Medicina (Kaunas, Lithuania) Aug 2023Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of... (Review)
Review
Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy.
Topics: Humans; Otosclerosis; Vertigo; Stapes Surgery; Deafness; Osteogenesis
PubMed: 37629775
DOI: 10.3390/medicina59081485 -
Otology & Neurotology : Official... Apr 2021Review surgical outcomes of stapedectomy for otosclerosis in patients with Menierè's disease.
OBJECTIVE
Review surgical outcomes of stapedectomy for otosclerosis in patients with Menierè's disease.
STUDY DESIGN
Retrospective case review.
SETTING
Tertiary referral center.
PATIENTS
Patients with otosclerosis and Menière's disease undergoing stapedectomy between 2010 and 2017.
INTERVENTION
Stapedectomy.
MAIN OUTCOME MEASURES
Pre- and postoperative hearing and complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone frequency, pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS).
RESULTS
Among 1,499 patients with otosclerosis, the incidence of concomitant Menière's disease was 1.7%. Fifteen patients with otosclerosis and Menière's disease underwent stapedectomy, 12 primary and three revisions. Mean AC PTA was 43 dB preoperatively, and 25 dB postoperatively (p = 0.0007), while the ABG improved on average from 20 to 5 dB (p = 0.0001). There was no significant difference in BC PTA or WRS postoperatively. Two patients experienced fluctuation of hearing in the postoperative period, one of which resolved with a course of steroids. The mean follow-up time was 41 months.
CONCLUSIONS
In patients with otosclerosis and Menière's disease, stapedectomy provides excellent hearing outcomes in a majority of patients. As is characteristic of Menière's disease, some patients will continue to experience fluctuating hearing postoperatively, which may progress to severe sensorineural hearing loss. Menière's disease may not be an absolute contraindication to stapes surgery.
Topics: Audiometry, Pure-Tone; Contraindications; Humans; Meniere Disease; Otosclerosis; Retrospective Studies; Stapes Surgery; Treatment Outcome
PubMed: 33710988
DOI: 10.1097/MAO.0000000000003005 -
The Annals of Otology, Rhinology, and... Mar 2018To evaluate whether removal of the stapes head and not the entire stapes superstructure prevents footplate complications.
OBJECTIVE
To evaluate whether removal of the stapes head and not the entire stapes superstructure prevents footplate complications.
STUDY DESIGN
Prospective study.
PATIENTS
One hundred and forty-five patients with otosclerosis were included. Patients were divided into 2 groups as follows: Individuals in group 1 (n = 75) underwent removal of the entire stapes superstructure; individuals in group 2 (n = 70) underwent removal of the stapes head only. These 2 groups were further subdivided into 2 subgroups based on the type of otosclerosis. Group 1a included 55 cases of marginal otosclerosis, while group 1b included 15 diffusive and 5 biscuit otosclerosis cases. Group 2a included 51 marginal otosclerosis cases, while group 2b included 14 diffuse and 5 biscuit otosclerosis cases. Estimations were made regarding statistical correlation between type of reversal steps stapedotomy, otosclerosis type, incidence of footplate complications, and hearing results.
RESULTS
There were 9 footplate complications in group 1b and no complications in group 2b. This difference was significant. Air-bone gap closure to within 10 dB was achieved in 65% of cases in group 1b and 94.7% in group 2b. This difference was significant.
CONCLUSION
The new stapedotomy prevented footplate complications and improved hearing results in diffuse and biscuit otosclerosis.
Topics: Adult; Aged; Female; Hearing Loss, Conductive; Hearing Tests; Humans; Italy; Male; Middle Aged; Otosclerosis; Outcome and Process Assessment, Health Care; Postoperative Complications; Stapes; Stapes Surgery
PubMed: 29298506
DOI: 10.1177/0003489417751156 -
Otolaryngologic Clinics of North America Apr 2018Diagnosis and treatment of advanced otosclerosis can be controversial. In 1961, House and Sheehy defined advanced otosclerosis as hearing loss in air conduction... (Review)
Review
Diagnosis and treatment of advanced otosclerosis can be controversial. In 1961, House and Sheehy defined advanced otosclerosis as hearing loss in air conduction threshold by 85 dB with nonmeasurable bone conduction. Recently, the definition of advanced otosclerosis is mostly based on the decrease of speech recognition. There are some treatment modalities: stapes surgery and hearing aids, cochlear implantation, or direct acoustic cochlear implant. The authors propose a new algorithm for treatment. If the patient is treated with cochlear implantation, the surgeon should be cautious for facial nerve stimulation after surgery because it is the most prevalent complication.
Topics: Bone Conduction; Cochlear Implantation; Cochlear Implants; Combined Modality Therapy; Hearing Loss, Mixed Conductive-Sensorineural; Humans; Magnetic Resonance Imaging; Otosclerosis; Speech Perception; Stapes Surgery; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29502727
DOI: 10.1016/j.otc.2017.11.012 -
Otolaryngology--head and Neck Surgery :... Apr 2020The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to... (Comparative Study)
Comparative Study Observational Study
OBJECTIVE
The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy.
STUDY DESIGN
Retrospective observational study of national health care claims.
SETTING
2003 to 2016 Optum Clinformatics Data Mart.
SUBJECTS AND METHODS
In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery.
RESULTS
The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; test, < .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; test, < .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; test, < .0001). A higher number of children was correlated with lower age for both females (Pearson, = -0.3817, < .0001) and males (Pearson, = -0. 3675, < .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children ((3, 6021) = 336.93, < .001, = 0.1437) with no significant interaction between sex and number of children ( = .186).
CONCLUSION
Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis.
Topics: Age Factors; Female; Humans; Male; Middle Aged; Otosclerosis; Parity; Pregnancy; Retrospective Studies; Sex Factors; Stapes Surgery
PubMed: 32093549
DOI: 10.1177/0194599820907093 -
Human Genetics Apr 2022Otosclerosis is a relatively common cause of hearing impairment, characterized by abnormal bone remodeling of the middle and inner ear. In about 50-60% of the patients,... (Review)
Review
Otosclerosis is a relatively common cause of hearing impairment, characterized by abnormal bone remodeling of the middle and inner ear. In about 50-60% of the patients, the disease is present in a familial form. In most of these families, otosclerosis seems to be caused by a small number of genetic factors (oligogenic) while only in a small number of families the disease seems to be truly monogenic. In the remaining patients a complex genetic form of otosclerosis is present. Several studies have aimed to identify the genetic factors underlying otosclerosis, which has led to the identification of eight published loci for monogenic otosclerosis, as well as several genes and one chromosomal region (11q13.1) with a clear association with otosclerosis. Implementation of next-generation sequencing (NGS) in otosclerosis research has led to the identification of pathogenic variants in MEPE, ACAN and SERPINF1, although the pathogenic role of the latter is under debate. In addition, a recent GWAS can be considered a breakthrough for otosclerosis as it identified several strong associations with otosclerosis and suggested new potential candidate genes. These recent findings are important for unraveling the genetic architecture of otosclerosis. More future studies will help to understand the complete pathogenesis of the disease.
Topics: Ear, Inner; Humans; Multifactorial Inheritance; Otosclerosis
PubMed: 34498117
DOI: 10.1007/s00439-021-02357-1 -
Ear, Nose, & Throat Journal Feb 2021Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the... (Review)
Review
OBJECTIVES
Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the conductive hearing loss caused by otosclerosis consists of either rehabilitation with hearing aids or performing surgery. Given the risks of hearing impairment and vertigo associated with the surgery, there has been a desire to advance the practice to minimize the complications. The so-called "non-contact" or "no touch" techniques with the use of various lasers are in current practice. This review article will cover the surgical aspects, the theory behind laser and the various types used in stapes surgery. It will also review the evidence of laser versus conventional stapes surgery and the comparison of different laser types.
METHODS
A literature search up to December 2019 was performed using Pubmed and a nonsystematic review of appropriate articles was undertaken. Keywords used were stapes, surgery, laser, stapedectomy, and stapedotomy.
RESULTS
Overall, there is no evidence to say laser fenestration is better than conventional fenestration techniques; however, with the micro drill, there is an increased risk of footplate fracture and sensorineural hearing loss. There is an increased risk of tinnitus with the laser compared to conventional techniques. Studies have favored the CO laser over potassium titanyl phosphate (KTP) and erbium-doped yttrium aluminium garnet (Erbium-YAG) lasers for postoperative closure of the air-bone gap; and KTP laser has less thermal, mechanical, and sound effects compared with the thulium and carbon dioxide (CO) lasers. There is an increased risk if inner ear complications with the thulium laser.
CONCLUSIONS
It can be deduced that theoretically and practically, the thulium laser is less safe compared to the KTP and CO lasers. The choice of laser used depends on the surgeon's preference, as well as availability, cost, side effects profile, as well as ease of use.
Topics: Hearing Loss, Conductive; Humans; Laser Therapy; Otosclerosis; Stapes Surgery; Treatment Outcome
PubMed: 32603217
DOI: 10.1177/0145561320937828