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European Annals of Otorhinolaryngology,... May 2020To evaluate operative comfort and stress in patients undergoing stapedotomy for otosclerosis under local versus general anesthesia. (Comparative Study)
Comparative Study
OBJECTIVES
To evaluate operative comfort and stress in patients undergoing stapedotomy for otosclerosis under local versus general anesthesia.
MATERIAL AND METHODS
Consecutive otosclerosis patients managed over a 9-month period responded to 3 validated questionnaires to assess peri- and post-operative comfort: Glasgow Benefit Inventory, Cohen's Perceived Stress Scale and the Posttraumatic Stress Disorder Checklist Scale. These results and audiometric data were compared between local and general anesthesia groups.
RESULTS
Twenty-one patients were included in the local anesthesia group and 7 in the general anesthesia group, after exclusion of patients with history of otosclerosis surgery. There was no significant inter-group difference on Glasgow Benefit Inventory (P=0.38) or Posttraumatic Stress Disorder Checklist Scale (P=0.86). Perceived Stress Scale scores were higher in the general anesthesia group (P=0.038). In total, 67% of patients reported no discomfort under local anesthesia, and 86% were ready to undergo the procedure under local anesthesia again. There were no significant differences in postoperative symptoms, or in air-bone gap≤10dB (local anesthesia 81%, general anesthesia 71%; P=0.156).
CONCLUSIONS
Local anesthesia in otosclerosis surgery did not increase stress or postoperative symptoms compared to general anesthesia. Audiometric results were not affected by type of anesthesia.
Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesia, Local; Female; Humans; Male; Middle Aged; Otosclerosis; Patient Comfort; Retrospective Studies; Self Report; Stapes Surgery; Stress, Psychological; Treatment Outcome; Young Adult
PubMed: 31734143
DOI: 10.1016/j.anorl.2019.10.014 -
International Journal of Pediatric... Mar 2023Juvenile Otosclerosis (JO) and Congenital Stapes Footplate Fixation (CSFF) are rare ossicular chain disorders seen in the paediatric population and present with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Juvenile Otosclerosis (JO) and Congenital Stapes Footplate Fixation (CSFF) are rare ossicular chain disorders seen in the paediatric population and present with conductive hearing loss. Ongoing controversy exists regarding the role of surgical intervention in JO and CSFF given the poorer hearing outcomes and complications when compared with surgical intervention for adult otosclerosis. The objective of this study is to assess the published data on the surgical outcomes of JO and CSFF in order to guide clinicians and counsel patients on the various medical options for these disease entities.
METHODS
A systematic review of MEDLINE, EMBASE and Cochrane was performed with inclusion criteria of children with JO or CSFF and hearing outcomes following stapes surgery. Studies identified by the search were reviewed and assessed by two independent reviewers in line with the PRISMA guidelines.
RESULTS
464 articles were initially reviewed and 28 articles met inclusion in the systematic review and meta-analysis. A total of 810 ears (473 and 337 cases of JO and CSFF respectively) underwent stapes surgery. Average age at time of surgery for JO and CSFF was 14.3 and 10.2 years old respectively. The mean pre-operative Air-Bone-Gap (ABG) for JO and CSFF was 31.8 ± 5.2 dB and 39.4 ± 10 dB respectively. Following stapes surgery, the mean post-operative ABG for JO and CSFF was 9.6 ± 6 dB and 19.2 ± 12.5 dB respectively. Surgical success rate (defined as ABG <10 dB) was 81% for JO and 41% for CSFF. Mean ABG gain for JO and CSFF was 24.8 dB (95% CI: 18.6-33.1) and 22.6 dB (95% CI: 18.4-27.8) respectively. The reported number of dead ears was 4/473 (0.8%) for JO and 2/337 (0.6%) for CSFF. 23 cases (2.8%) reported sensorineural hearing loss (SNHL) >10 dB.
CONCLUSION
CSFF was associated with poorer hearing outcomes compared to JO, however both entities showed similar improvement in ABG post operatively. Counselling patients and their families on the surgical success rates and complications of JO or CSFF is an important part of the decision making process when deciding between a surgical option or conservative measures such as hearing aids.
Topics: Adult; Child; Humans; Stapes; Otosclerosis; Stapes Surgery; Ear Ossicles; Hearing Loss, Conductive; Retrospective Studies; Treatment Outcome
PubMed: 36709714
DOI: 10.1016/j.ijporl.2022.111418 -
Brazilian Journal of Otorhinolaryngology 2018Otospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically,... (Review)
Review
INTRODUCTION
Otospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically, otospongiosis is characterized by progressive conductive and/or mixed hearing loss and by tinnitus.
OBJECTIVE
A review of the last two decades of publications that report the degree of tinnitus improvement with stapes surgery.
METHODS
125 articles published in the last 20 years mentioning the relationship between otosclerosis and tinnitus. Literature has always shown that the hearing improvement after stapes surgery was the main result sought and found. However, recent articles has reinforced the need for surgery for the tinnitus improvement. The ideal time to assess tinnitus through different scales is in the sixth month post-operative. The estimated average hearing improvement is 93% and tinnitus is 85.52%.
RESULTS
Summaries of 12 articles were reviewed which fulfilled the search criteria of the survey, and 8 studies were included in the study according the selection criteria. This studies investigating the degree of tinnitus improvement with stapes surgery, using different scales as: tinnitus functional index, visual analog scale, tinnitus functional index and visual analog scale, visual analog scale and "questionnaire asking about tinnitus", Newman's method and Tinnitus Score Advocated by the Japan Audiological Society. The total of the samples of the evaluated articles was of 254 participants.
CONCLUSION
We conclude that stapes surgery is effective for the treatment of tinnitus (average improvement is 85.52%), and hearing loss (average improvement is 93%). When deciding about the surgical indication in patients with otosclerosis, the presence and level tinnitus should be considered as well as the level of hearing.
Topics: Hearing Loss; Humans; Otosclerosis; Reproducibility of Results; Severity of Illness Index; Stapes Surgery; Tinnitus; Treatment Outcome
PubMed: 29339029
DOI: 10.1016/j.bjorl.2017.12.005 -
Radiologia 2016Otosclerosis is a primary osteodystrophy of the temporal bone that causes progressive conductive hearing loss. The diagnosis is generally clinical, but multidetector CT... (Review)
Review
Otosclerosis is a primary osteodystrophy of the temporal bone that causes progressive conductive hearing loss. The diagnosis is generally clinical, but multidetector CT (MDCT), the imaging technique of choice, is sometimes necessary. The objective of this article is to systematically review the usefulness of imaging techniques for the diagnosis and postsurgical assessment of otosclerosis, fundamentally the role of MDCT, to decrease the surgical risk.
Topics: Humans; Magnetic Resonance Imaging; Multidetector Computed Tomography; Otosclerosis
PubMed: 27267384
DOI: 10.1016/j.rx.2016.04.008 -
Acta Oto-laryngologica Jun 2021The bony otic capsule is comprised of highly mineralized and dense compact bone. It is rarely remodelled and degenerative changes, therefore, accumulate around the inner...
BACKGROUND
The bony otic capsule is comprised of highly mineralized and dense compact bone. It is rarely remodelled and degenerative changes, therefore, accumulate around the inner ear. It is also a predilection site for the pathological remodelling seen in otosclerosis. Morphometric studies have documented increased numbers of dead osteocytes and microcracks in the human otic capsule. Microcracks may disrupt the lacuno-canalicular network and cause osteocyte apoptosis ultimately breaking up the perilabyrinthine bone signalling pathways and dynamics. This may be important to understand the pathogenesis of remodelling diseases like otosclerosis.
AIMS/OBJECTIVES
This study describes the spatial and regional distribution of microcrack surface density in relation to the inner ear and compares it to that previously recorded for otosclerosis.
MATERIAL AND METHODS
Forty-two temporal bones and five ribs were used. All samples were undecalcified, bulk stained in basic fuchsin and plastic embedded. Unbiased stereology was used to estimate the true surface density of microcracks (mm/mm) in perilabyrinthine bone.
RESULTS
The surface density of microcracks accumulates around the inner ear spaces, particularly in the lateral window regions, and increases with age.
CONCLUSIONS AND SIGNIFICANCE
This study documents the spatial and temporal association between microfractures and otosclerosis in the otic capsule.
Topics: Ear, Inner; Female; Humans; Male; Otosclerosis; Ribs; Surface Properties; Temporal Bone
PubMed: 33825609
DOI: 10.1080/00016489.2021.1905875 -
Otolaryngologic Clinics of North America Apr 2018Since the original carved Teflon stapes over vein graft, stapedectomy prostheses have undergone evolution. Prostheses shapes, materials, and surgical techniques for... (Review)
Review
Since the original carved Teflon stapes over vein graft, stapedectomy prostheses have undergone evolution. Prostheses shapes, materials, and surgical techniques for placement have reflected advances in biomaterials and surgical tools. The variability in prostheses has reflected alternative techniques of stapedectomy and stapedotomy and differing strategies for attachment to the incus. Although many iterations of stapes prostheses have been proposed, excellent results can be achieved with various prostheses designed to rest on tissue grafts in stapedectomy techniques or pass through the footplate in stapedotomy techniques when used by surgeons experienced with technique details specific to the selected prosthesis.
Topics: History, 20th Century; History, 21st Century; Humans; Ossicular Prosthesis; Otosclerosis; Prosthesis Design; Stapes Surgery
PubMed: 29502725
DOI: 10.1016/j.otc.2017.11.010 -
Otology & Neurotology : Official... Jun 2024To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to...
OBJECTIVES
To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to facilitate the identification of the round window membrane and the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.
STUDY DESIGN
Retrospective case-series study.
SETTING
Tertiary academic CI center.
PATIENTS AND METHODS
This study was conducted on patients with far advanced otosclerosis who underwent endoscopic-assisted CI between January 2010 and June 2020 at the same CI center. The minimum follow-up period was 2 years after surgery.
RESULTS
Fourteen patients were included in the study. Ten patients had undergone a previous stapedotomy. Electrode insertion in the scala tympani was successfully accomplished in all cases included in the study. There was a statistically significant improvement in pure-tone average and speech discrimination scores in all cases of the study group (p < 0.0001). There were no statistically significant differences in postoperative pure-tone average or speech discrimination scores between cases with and without cochlear ossification or between cases with and without a previous stapedotomy (p > 0.05).
CONCLUSION
Endoscopic-assisted CI is an effective option for hearing restoration in patients with far advanced otosclerosis. Otoendoscopy can facilitate visualization and access to the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.
Topics: Humans; Otosclerosis; Male; Female; Retrospective Studies; Middle Aged; Cochlear Implantation; Endoscopy; Adult; Aged; Treatment Outcome
PubMed: 38728555
DOI: 10.1097/MAO.0000000000004192 -
European Archives of... Aug 2022To analyse surgical and auditory outcomes after cochlear implantation in otosclerosis and to compare them to the outcomes in patients with post-lingual hearing loss with...
PURPOSE
To analyse surgical and auditory outcomes after cochlear implantation in otosclerosis and to compare them to the outcomes in patients with post-lingual hearing loss with different aetiology.
METHODS
Medical records of 17 subjects (22 ears) diagnosed with otosclerosis were compared to 21 controls (25 ears) matched by age, sex, duration of hearing loss and experience with cochlear implant in years. Demographic characteristics, surgical complications, facial nerve stimulation, number and reason for deactivated electrodes and auditory outcome (monosyllabic word score) were analysed. The auditory outcome was further evaluated according to the anatomical localisation of the otosclerotic lesions (grades) and compared between patients with active and deactivated electrodes.
RESULTS
Otosclerotic patients showed similar surgical outcome in comparison to the controls. A low frequency (13.6%) of facial nerve stimulation was observed in otosclerosis. A significantly higher (p = 0.014) number of deactivated electrodes (4.3%) in subjects with otosclerosis in comparison to non-otosclerosis patients (1.6%) was found. A trend of less speech discrimination of monosyllabic words (65%) in otosclerosis than in non-otosclerosis patients (80%) (p = 0.109) and no difference in the postoperative auditory assessment with regard to the disease grade and electrode disabling was found.
CONCLUSIONS
Cochlear implantation by otosclerosis provides excellent auditory outcome with a low rate of surgical complications. Alteration in fitting strategy as electrodes disabling is frequently needed to overcome complications as incomplete insertion, facial nerve stimulation and poor sound quality.
Topics: Cochlear Implantation; Cochlear Implants; Deafness; Hearing Loss; Humans; Otosclerosis; Retrospective Studies; Treatment Outcome
PubMed: 34741651
DOI: 10.1007/s00405-021-07157-x -
Orvosi Hetilap Dec 2019Otosclerosis is a bone remodeling disorder affecting exclusively the human temporal bone which causes small bony lesions in the otic capsule. The symptoms depend on the...
Otosclerosis is a bone remodeling disorder affecting exclusively the human temporal bone which causes small bony lesions in the otic capsule. The symptoms depend on the location and the extent of the otosclerotic foci. Hence, clinically the most relevant sign is the conductive hearing loss due to the stapedial otosclerosis with fixation of the stapes footplate. In many cases, the specific anamnestic features, the age of presentation and usually the absence of tympanic membrane pathology can provide a strong clinical suspicion for otosclerosis. Although audiometric and imaging examinations and VEMP testing can confirm our preoperative diagnosis, the histolopathologic examination of the removed stapes footplate is the most accurate way to determine the diagnosis. Orv Hetil. 2019; 160(51): 2007-2011.
Topics: Audiometry; Hearing Loss, Conductive; Humans; Otosclerosis; Stapes; Stapes Surgery
PubMed: 31838860
DOI: 10.1556/650.2019.31583 -
Acta Oto-laryngologica Mar 2023Otosclerosis is a common ear disease that causes fixation of the stapes and conductive hearing impairment. However, the pathogenesis of otosclerosis is still unknown....
BACKGROUND
Otosclerosis is a common ear disease that causes fixation of the stapes and conductive hearing impairment. However, the pathogenesis of otosclerosis is still unknown. Otosclerosis could be associated with the unique bony environment found in the otic capsule. Normal bone remodelling is almost completely absent around the inner ear after birth allowing degenerative changes and dead osteocytes to accumulate. High levels of inner ear anti resorptive osteoprotegerin (OPG) is most likely responsible for this capsular configuration. Studies have demonstrated how osteocyte lifespan variation creates occasional clusters of dead osteocytes, so-called cellular voids, at otosclerotic predilection sites in the human otic capsule. These cellular voids have been suggested as possible starting points of otosclerosis.
AIM
To describe the cellular viability in otosclerotic lesions and compare it to that of cellular voids.
MATERIALS AND METHODS
The study was based on unbiased stereological quantifications in undecalcified human temporal bones with otosclerosis.
RESULTS
Osteocyte viability was found to vary within the otosclerotic lesions. Furthermore, the results presented here illustrate that inactive otosclerotic lesions consist of mainly dead interstitial bone, much like cellular voids.
CONCLUSIONS AND SIGNIFICANCE
Focal degeneration in the otic capsule may play an important role in the pathogenesis of otosclerosis.
Topics: Humans; Bone Remodeling; Cell Survival; Ear, Inner; Osteocytes; Osteoprotegerin; Otosclerosis; Stapes; Temporal Bone
PubMed: 36639139
DOI: 10.1080/00016489.2023.2164904