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Orvosi Hetilap May 2020Otosclerosis is a human-specific ear disease characterised by complex bone-remodelling with multifactorial aetiology. It affects the bony labyrinth capsule and... (Review)
Review
Otosclerosis is a human-specific ear disease characterised by complex bone-remodelling with multifactorial aetiology. It affects the bony labyrinth capsule and consequently fixates the stapes to the oval window rim. The fixation of the ossicular chain leads to a decrease in the middle ear's acoustic impedance-fitting and amplifier function that leads to conductive hearing loss. The process is progressive and when it involves the inner ear structures, it deteriorates the sensorineural function as well. The course of the illness can be prevented or delayed if hearing reconstructive surgery is performed on time. The development of stapes surgery spans the 20th century, and despite the major surgical steps - laid down by Shea and Marquet in the 1960s - are quite conservative, fine adjustments are still being made mainly due to technical progress. Several studies confirm that stapedotomy remained the first-to-offer therapeutic option in otosclerosis. With an adequate surgical technique, significant improvement can be achieved in the air conduction threshold, the air-bone gap may be minimalized or ceased over the speech frequencies, which significantly improves the quality of life of the patients. In this quest, we reviewed the Hungarian and the international literature as well in context with otosclerosis, with special attention to the newest methods in diagnostics and treatment management. Orv Hetil. 2020; 161(19): 780-788.
Topics: Bone Conduction; Hearing Loss; Hearing Loss, Conductive; Humans; Ossicular Prosthesis; Otosclerosis; Quality of Life; Retrospective Studies; Stapes Surgery; Treatment Outcome
PubMed: 32365050
DOI: 10.1556/650.2020.31701 -
Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.Otolaryngology--head and Neck Surgery :... Nov 2016To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.
DATA SOURCES
PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.
METHODS
Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval.
RESULTS
Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22).
CONCLUSIONS
Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.
Topics: Cochlear Implantation; Humans; Otosclerosis; Outcome and Process Assessment, Health Care; Salvage Therapy; Stapes Surgery
PubMed: 27329418
DOI: 10.1177/0194599816655310 -
European Archives of... Nov 2021To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery. (Review)
Review
OBJECTIVE
To provide an overview of the current status regarding the parallel use of the endoscope and the laser in middle ear surgery.
METHODS
Comprehensive Pubmed search from 1975 to 2020 including clinical articles, of any type, reporting the combined use of a laser and an endoscope. Purely experimental and non-human studies were excluded.
RESULTS
Reports on the application of the laser in pediatric and adult endoscopic middle ear surgery (EES) are increasing since 2013. Laser-assisted EES is performed for cholesteatoma, non-squamous chronic otitis media, ossicular fixation, otosclerosis and tympanic paraganglioma. The improved haemostasis and the non-contact ablation of tissue around the ossicles and inaccessible areas, represent unique advantages. In stapes surgery, the resection of stapes superstructure with minimal force and the non-contact footplate fenestration are potential advantages. Proper use of the laser, i.e. direction away from the facial nerve and the open labyrinth and safe energy settings have resulted in minimal complications.
CONCLUSION
Based on the increasing number of publications, endoscopic ear surgeons show an interest in using a laser for specific operative tasks. The configuration of a hand-held laser probe does not differ significantly from other otological instruments and therefore is easy to use alongside the endoscope, even in children. The 'handicap' of single-handed surgery can be partially offset by the bloodless and non-contact laser ablation of tissue.
Topics: Adult; Child; Ear, Middle; Humans; Lasers; Otologic Surgical Procedures; Otosclerosis; Stapes Surgery
PubMed: 33938993
DOI: 10.1007/s00405-021-06807-4 -
Otolaryngology--head and Neck Surgery :... Jun 2021This study sought to determine whether a history of pregnancy or bilateral oophorectomy is associated with subsequent otosclerosis development or disease severity.
OBJECTIVE
This study sought to determine whether a history of pregnancy or bilateral oophorectomy is associated with subsequent otosclerosis development or disease severity.
STUDY DESIGN
Population-based case-control study.
SETTING
Olmsted County, Minnesota.
METHODS
Women diagnosed with otosclerosis were matched to 3 women without otosclerosis based on age and historical depth of medical records. Associations of prior delivery and bilateral oophorectomy with subsequent development of otosclerosis and with pure-tone average (PTA) at the time of otosclerosis diagnosis were evaluated.
RESULTS
We studied 1196 women: 299 cases of otosclerosis and 897 matched controls. The odds ratio for the association of ≥1 delivery with otosclerosis was 1.16 (95% confidence interval [CI] 0.85-1.60; = .35). Odds ratios for the associations of 1, 2, 3, or ≥4 deliveries with otosclerosis were 1.22 (0.83-1.80), 1.09 (0.71-1.68), 1.28 (0.77-2.12), and 1.00 (0.54-1.84), respectively. The odds ratio for the association of prior bilateral oophorectomy with otosclerosis was 1.12 (0.58-2.18; = .73). In cases with otosclerosis, PTA at diagnosis was not significantly higher for women with ≥1 delivery as compared with those without (median 45 dB hearing loss [HL] [interquartile range {IQR} 36-55] vs 43 [IQR 34-53]; = 0.18) but was significantly higher for women with bilateral oophorectomy compared with those without (median 54 dB HL [IQR 44-61] vs 44 [IQR 34-53]; = .03).
CONCLUSION
These data do not support a relationship between endogenous estrogen exposure and development of otosclerosis. Women with otosclerosis who had a history of pregnancy did not have significantly worse hearing at the time of diagnosis, suggesting that pregnancy is not associated with disease severity.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Estrogens; Female; Humans; Middle Aged; Otosclerosis; Ovariectomy; Parity; Risk Assessment; Severity of Illness Index; Young Adult
PubMed: 33107781
DOI: 10.1177/0194599820966295 -
American Journal of Otolaryngology 2020Otosclerosis is a widespread disease but the etiopathogenesis is still not fully understood. Hormonal factors especially estrogens are accused in recent years. The study...
OBJECTIVE
Otosclerosis is a widespread disease but the etiopathogenesis is still not fully understood. Hormonal factors especially estrogens are accused in recent years. The study aimed to evaluate the levels of G-protein associated membrane estrogen receptor-1 (GPER-1) and sex-hormones in patients with otosclerosis.
SUBJECT AND METHODS
The study included 60 people (30 otosclerosis patients, 30 control group). Serum sex-hormone (estradiol, progesterone, prolactin and total testosterone) and GPER-1 levels were measured in otosclerosis patients and compared with the normal population. For the otosclerosis group, air conduction and bone conduction thresholds and air-bone gaps were viewed from audiograms and the relationships between hearing and GPER-1 or sex-hormone levels were also investigated.
RESULTS
Sex-hormone levels were not different between the groups. GPER-1 level was significantly lower in the otosclerosis group [3.1353 (0.76-8.21) ng/mL] than the control group [5.4773 (0.96-20.31) ng/mL] (p =0.017). Differential diagnosis with ROC analysis for the GPER-1 level was also significant (p=0.017). GPER-1 level was significantly lower for the females than the males in the otosclerosis group (p=0.043). Serum estradiol, progesterone, and prolactin levels were significantly higher (p=0.02, p =0.029 and p=0.019 respectively) and the GPER-1 level was significantly lower (p= 0.04) in the female patients compared to the female controls. There was no statistically significant relationship between GPER-1 or sex-hormone levels and hearing parameters.
CONCLUSION
GPER-1 level was lower in the otosclerosis patients compared to healthy volunteers and also lower in females than males in the patient group. Female sex-hormone levels were higher and GPER-1 level was lower in the female patient group than the female control group. Neither GPER-1 nor sex-hormone levels were not predictive of hearing levels. These findings indicate that sex-hormones especially estrogen and GPER-1 might have a potential role in the etiopathogenesis of otosclerosis. This is the first study in the literature that investigates the GPER-1 values in otosclerosis.
Topics: Adult; Biomarkers; Bone Conduction; Estrogens; Female; Gonadal Steroid Hormones; Humans; Male; Middle Aged; Otosclerosis; Receptors, Estrogen; Receptors, G-Protein-Coupled; Sex Factors
PubMed: 32144019
DOI: 10.1016/j.amjoto.2020.102442 -
Otology & Neurotology : Official... Oct 2022Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution...
INTRODUCTION
Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology.
METHODS
One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC.
RESULTS
Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001).
CONCLUSION
IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.
Topics: Aged; Diverticulum; Ear, Inner; Humans; Male; Otosclerosis; Petrous Bone; Temporal Bone; Tomography, X-Ray Computed
PubMed: 36075107
DOI: 10.1097/MAO.0000000000003665 -
Vestnik Otorinolaringologii 2023The article presents various classifications of forms of otosclerosis (OS), which change with the development of diagnostic methods. At the same time, according to the...
The article presents various classifications of forms of otosclerosis (OS), which change with the development of diagnostic methods. At the same time, according to the literature, a unified OS classification has not yet been adopted. All existing classifications are imperfect to some extent. The classification of clinical forms of OS according to TPA data makes it possible to determine the indications for surgical treatment and to suggest its possible effect, but not the localization of OS foci. X-ray classifications of localization of OS foci indicate their diversity, distribution, and do not always correlate with the type of hearing loss. At the same time, modern diagnostics of OS should be based on audiological data, localization of foci and their density according to the results of X-ray methods of examination. Based on the examination and treatment of 1532 patients with various forms of OS, a modern clinical and radiological classification of the disease is proposed, based precisely on these provisions. This classification, in our opinion, will improve the quality of diagnosis of various forms of OS, will allow to differentiate the tactics of treating patients with this disease to stabilize hearing loss, indications for surgical treatment, suggest its effectiveness with a reduction in the risk of surgical failures and possible further rehabilitation of the patient.
Topics: Humans; Otosclerosis; Stapes Surgery; Hearing Loss; Radiography; Tomography, X-Ray Computed; Deafness
PubMed: 37970764
DOI: 10.17116/otorino20238805112 -
International Journal of Audiology Nov 2020To compare wideband absorbance (WBA) patterns between ears with otosclerosis and normal hearing ears and to investigate if WBA findings could be useful in the diagnosis...
To compare wideband absorbance (WBA) patterns between ears with otosclerosis and normal hearing ears and to investigate if WBA findings could be useful in the diagnosis of otosclerosis. WBA was obtained at 107 frequency samples ranging from 0.226 to 8 kHz (24 per octave). A T-test was performed to compare between WBA in ears with otosclerosis and in normal hearing ears. The ability of WBA to discriminate between the patients with otosclerosis from the normal hearing participants was tested with a receiver operating characteristics (ROC) curve analysis. Thirty-five patients with otosclerosis (age 31-64) and thirty-five normal hearing volunteers (age 32-64). In frequency range 0.432-1.059 kHz, mean WBA in otosclerosis was significantly lower than mean WBA in normal hearing ears and in frequency range 4.238-8 kHz mean WBA in otosclerosis was significantly higher than mean WBA in normal hearing ears. The ROC analysis revealed that ears with otosclerosis and normal hearing ears could be distinguished based on mean WBA in frequency range >0.5 ≤ 1 kHz (AUC = 0.673) and based on mean WBA in frequency range >4 ≤ 8 kHz (AUC = 0.769). Our results suggest that WBA findings in ears with otosclerosis differ from WBA findings in normal hearing ears.
Topics: Acoustic Impedance Tests; Adult; Ear; Hearing; Humans; Middle Aged; Otosclerosis; ROC Curve
PubMed: 32633634
DOI: 10.1080/14992027.2020.1785644 -
European Archives of... Nov 2021Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known...
PURPOSE
Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile.
METHODS
Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group.
RESULTS
Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon's test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups.
CONCLUSION
Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.
Topics: Audiometry, Pure-Tone; Humans; Lasers; Operating Rooms; Otosclerosis; Retrospective Studies; Stapes Surgery; Treatment Outcome
PubMed: 33594470
DOI: 10.1007/s00405-021-06672-1 -
Aerospace Medicine and Human Performance Dec 2015When an aircrew member is referred for otosclerosis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of...
BACKGROUND
When an aircrew member is referred for otosclerosis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of otosclerosis in an aircrew population and to discuss the decisions about their flight waivers.
METHODS
There were 27 aircrew members who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.
RESULTS
Out of 16 patients who had surgery, 2 did not obtain a flight fitness waiver afterwards. Among the 14 who received waivers, 12 had no restrictions on their flight fitness. Among the nonoperated patients, 1 of 11 did not obtain a waiver. Seven patients were declared medically fit to fly without a waiver and three obtained a waiver.
DISCUSSION
Fitness was based on auditory and balance statuses and the follow-up of these findings. A postoperative CT-scan and the operative report were used to determine the quality of stapes surgery. Professional speech audiometry in noise might be as interesting. The results made it possible to determine a patient's fitness to fly with a waiver, which is more or less associated with restrictions. In our series, only 3 aircrew members out of 27 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who underwent surgery and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant vestibulocochlear assessment, stapes surgery may allow for a safe recovery of aviation activity.
Topics: Adult; Aerospace Medicine; Audiometry, Speech; Cohort Studies; Female; Humans; Male; Middle Aged; Otosclerosis; Physical Fitness; Postural Balance; Retrospective Studies; Return to Work; Stapes Surgery; Tomography, X-Ray Computed; Treatment Outcome; Work Capacity Evaluation
PubMed: 26630051
DOI: 10.3357/AMHP.4368.2015