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Otology & Neurotology : Official... Dec 2023Evaluate the safety and efficacy of exoscope-assisted stapedotomy.
OBJECTIVE
Evaluate the safety and efficacy of exoscope-assisted stapedotomy.
STUDY DESIGN
Retrospective chart review.
SETTING
Tertiary care neurotology clinic.
PATIENTS
Adult patients with otosclerosis undergoing stapedotomy.
INTERVENTIONS
Primary stapedotomy.
MAIN OUTCOME MEASURES
Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated.
RESULTS
A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group.
CONCLUSIONS
This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.
Topics: Adult; Humans; Retrospective Studies; Treatment Outcome; Stapes Surgery; Ear, Middle; Bone Conduction; Otosclerosis
PubMed: 37939357
DOI: 10.1097/MAO.0000000000004042 -
European Archives of... Aug 2021These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear... (Review)
Review
OBJECTIVE
These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear surgery develops across the globe. The main objective of this study is to gather and compile well-documented and reliable data regarding surgical outcomes for the endoscopic approach to stapes surgery up to this date.
MATERIALS AND METHODS
Publications in English were searched in the PUBMED/MEDLINE database and were systematically reviewed. A total of 16 articles were reviewed according to the inclusion criteria, obtaining a total of 573 patients managed surgically for otosclerosis, using an endoscopic approach. Data were systematically extracted and compared across variables.
RESULTS
Data were obtained as follows: mean age of 43 years; female proportion of 60%; 3 mm endoscope diameter of 51%, 4 mm of 39%; titanium piston-type prostheses of 52% and Teflon of 48%; length of the prosthesis (mode) was 4.5 mm; 0.6 mm diameter of the piston of 81% and 0.4 mm of 19%; mean surgical time was 55 min. Hearing results, mean preoperative air-bone gap (ABG) 31 dB; mean postoperative ABG 9 dB; ABG improvement of 22 dB; an ABG closure rate to 20 dB or less of 92% and an ABG closure rate to 10 dB or less of 77%. Complication rates: intraoperative tympanic membrane perforation of 5%; postoperative vertigo of 11%; postoperative dysgeusia of 10%; reported a postoperative neurosensorial hearing loss of 0.2%; reported gusher phenomenon of one case (0.2%).
CONCLUSION
Endoscopic stapes surgery is completely achievable using 0º angle and 4-mm-diameter sinus surgery endoscope. Instrument availability should not be an obstacle to the development of this type of surgery in any otolaryngology department. Audiological outcomes are comparable to microscopic approaches.
Topics: Adult; Endoscopy; Female; Humans; Ossicular Prosthesis; Otosclerosis; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 33001293
DOI: 10.1007/s00405-020-06388-8 -
Journal of Visualized Experiments : JoVE Mar 2022In recent years there has been an increasing trend in the use of the endoscope to treat a variety of middle ear pathologies, including otosclerosis. Several studies...
In recent years there has been an increasing trend in the use of the endoscope to treat a variety of middle ear pathologies, including otosclerosis. Several studies comparing traditional microscopic and endoscopic stapes surgery have reported similar hearing results and an overall low rate of complications. The endoscope has unraveled its full potential in demanding settings of stapes surgery, such as unfavorable anatomy of the oval window niche or revision cases. Reduced manipulation of the chorda tympani and low rate of post-operative dysgeusia are further benefits to mention for endoscopic stapes surgery. Being a one-handed technique, management of bleeding, positioning, and crimping of the prosthesis may be challenging for novice endoscopic surgeons, so some training in endoscopic ear surgery is recommended before performing endoscopic stapedotomy. The problem of sharing the surgical field between the endoscope and the operating instruments could be easily overcome if proper instruments positioning is understood. One-handed bleeding control in the narrow space of the ear canal may represent an issue during the elevation of the tympano-meatal flap, possibly discouraging the surgeon since the preliminary steps of surgery. Following appropriate technique to raise the flap and the collaboration with the anesthesiology team in keeping the blood pressure low guarantee an adequate bleeding control in most cases. The aim of this article is to describe the entire surgical procedure of a transcanal exclusive endoscopic stapedotomy, from operating room set up and patient positioning to post-operative care. A step-by-step description of the surgical maneuvers with technical hints is reported, to guide the surgeon across the procedure and allow any ear surgeon to perform stapes surgery endoscopically.
Topics: Ear, Middle; Endoscopy; Humans; Otosclerosis; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 35311820
DOI: 10.3791/63061 -
European Archives of... Jan 2020To describe the procedures and investigate the hearing outcomes and complications after revision surgery for patients with otosclerosis in Sweden and compare these with...
PURPOSE
To describe the procedures and investigate the hearing outcomes and complications after revision surgery for patients with otosclerosis in Sweden and compare these with previously published reports and to investigate factors that may predict the outcomes of revision surgery.
METHODS
A total of 254 patients from the Swedish Quality Register for otosclerosis surgery who underwent surgery at 21 clinics were identified as having undergone revision surgery for otosclerosis from 2003 to 2013. Clinical records and audiograms from each of these patients were collected and analyzed.
RESULTS
Improvement in hearing by 20 dB or more and closure of air-bone gap (≤ 20 dB) was achieved in 43% and 69% of patients after a first revision operation and in 46% and 70% of patients after a second revision operation. Most patients who underwent surgery because of dizziness were relieved of their dizziness. Postoperative deafness occurred in 2.3% of patients. Prior successful otosclerosis surgery predicted successful revision surgery, especially after a second revision operation. Fixation of the incus or malleus and finding of no obvious reason for the conductive hearing loss predicted a worse hearing outcome.
CONCLUSIONS
The hearing results after revision surgery in Sweden is somewhat inferior to those of previously published results involving large centers. Postoperative deafness may be as much as fivefold more common after revision surgery than after primary surgery. Meticulous reading of previous charts and honest counseling regarding the risks and expectations is mandatory before planning revision surgery for otosclerosis.
Topics: Adolescent; Adult; Aged; Child; Female; Hearing Loss; Humans; Male; Middle Aged; Otosclerosis; Registries; Reoperation; Stapes Surgery; Sweden; Young Adult
PubMed: 31549194
DOI: 10.1007/s00405-019-05652-w -
Ear, Nose, & Throat Journal Feb 2021The study is aimed to assess the scope of endoscopic stapedotomy in overcoming technical challenges faced during conventional stapedotomy using operating microscope.... (Randomized Controlled Trial)
Randomized Controlled Trial
The study is aimed to assess the scope of endoscopic stapedotomy in overcoming technical challenges faced during conventional stapedotomy using operating microscope. Sixty-four patients with clinical and audiological diagnosis of otosclerosis were randomly assigned into one of the 2 groups-one underwent conventional stapedotomy using operating microscope, while the other group underwent endoscopic stapedotomy, the operating surgeon being the same for both groups, for all cases. The 2 groups were observed in terms of extent of the postero-superior canal bone curettage/drilling, chorda tympani repositioning, visualization of footplate area, surgical time from first incision to ear packing, post-operative morbidity in terms of post-operative pain, vertigo, hearing outcome, and changes in taste sensation. It was observed that irrespective of the width of the external auditory canal, endoscopic approach offered better access to the footplate area requiring lesser bone removal and chorda tympani repositioning. The operating time, post-operative pain, and changes in taste sensation were significantly less in the endoscopic group. However, no difference was noted in terms of the post-operative hearing outcome and incidence of vertigo. Endoscopic stapedotomy has clear advantages in terms of the technicality and accessibility to the working area as well as faster recovery.
Topics: Adult; Chorda Tympani Nerve; Ear Canal; Endoscopy; Female; Hearing; Humans; Male; Microscopy; Microsurgery; Operative Time; Otosclerosis; Postoperative Period; Stapes Surgery; Treatment Outcome
PubMed: 31288532
DOI: 10.1177/0145561319862216 -
Ear, Nose, & Throat Journal Aug 2022Otosclerosis is a disease of the osseous labyrinth. The disease causes 5% to 9% of all cases of hearing loss and 18% to 22% of conductive hearing loss. The treatment of...
BACKGROUND
Otosclerosis is a disease of the osseous labyrinth. The disease causes 5% to 9% of all cases of hearing loss and 18% to 22% of conductive hearing loss. The treatment of choice is a surgery. The hearing improvement after the operation is determined by various factors.
AIMS/OBJECTIVES
The aim of the analysis is to determinate changes in hearing after stapedoplasty in view of surgery side in the patients operated on otosclerosis by right-handed surgeons.
MATERIAL AND METHODS
The analysis involved patients hospitalized and operated on otosclerosis between 2012 and 2018. Only patients with their first middle ear surgery due to otosclerosis were included in the study. The patients were operated by 2 right-handed surgeons who used the same surgical technique and had similar experience in otosclerosis surgery. The study included patients who were divided into 2 groups: with self-tightening prosthesis and with manually tightening prosthesis.
RESULTS
The procedure performed by right-handed operators on the left side using prostheses requiring manual fixation on the incus was associated with poorer audiometric results compared to the results of surgeries on the right side. In patients with the self-tightening prostheses, the audiometric improvement of hearing was bilaterally comparable independently from operation side.
CONCLUSION
(1) The dependence of hearing improvement on the surgery side was demonstrated in cases of surgeries performed on the left ear by right-handed surgeons, particularly with manually tightening prosthesis. (2) Self-tightening prostheses in stapedotomy limit the human factor, reducing the risk of complications after otosclerosis surgery and provide repeatable hearing improvement.
Topics: Bone Conduction; Hearing; Humans; Ossicular Prosthesis; Otosclerosis; Retrospective Studies; Stapes Surgery; Surgeons
PubMed: 35916230
DOI: 10.1177/0145561320967336 -
Journal of Medical Genetics Jan 2024Otosclerosis is a common cause of adult-onset progressive hearing loss, affecting 0.3%-0.4% of the population. It results from dysregulation of bone homeostasis in the...
BACKGROUND
Otosclerosis is a common cause of adult-onset progressive hearing loss, affecting 0.3%-0.4% of the population. It results from dysregulation of bone homeostasis in the otic capsule, most commonly leading to fixation of the stapes bone, impairing sound conduction through the middle ear. Otosclerosis has a well-known genetic predisposition including familial cases with apparent autosomal dominant mode of inheritance. While linkage analysis and genome-wide association studies suggested an association with several genomic loci and with genes encoding structural proteins involved in bone formation or metabolism, the molecular genetic pathophysiology of human otosclerosis is yet mostly unknown.
METHODS
Whole-exome sequencing, linkage analysis, generation of CRISPR mutant mice, hearing tests and micro-CT.
RESULTS
Through genetic studies of kindred with seven individuals affected by apparent autosomal dominant otosclerosis, we identified a disease-causing variant in , encoding a key component of the PBAF chromatin remodelling complex. We generated CRISPR-Cas9 transgenic mice carrying the human mutation in the mouse orthologue. Mutant mice exhibited marked hearing impairment demonstrated through acoustic startle response and auditory brainstem response tests. Isolated ossicles of the auditory bullae of mutant mice exhibited a highly irregular structure of the incus bone, and their in situ micro-CT studies demonstrated the anomalous structure of the incus bone, causing disruption in the ossicular chain.
CONCLUSION
We demonstrate that otosclerosis can be caused by a variant in , with a similar phenotype of hearing impairment and abnormal bone formation in the auditory bullae in transgenic mice carrying the human mutation in the mouse orthologue.
Topics: Adult; Humans; Mice; Animals; Otosclerosis; Blister; Genome-Wide Association Study; Reflex, Startle; Hearing Loss; Phenotype; Mice, Transgenic; Mutation; DNA Helicases; Nuclear Proteins; Transcription Factors
PubMed: 37399313
DOI: 10.1136/jmg-2023-109264 -
Otolaryngologic Clinics of North America Jun 2018Chronic ear disease is a major cause of acquired hearing loss in the developing world. It is prevalent on every continent, but occurs more commonly in poorer nations... (Review)
Review
Chronic ear disease is a major cause of acquired hearing loss in the developing world. It is prevalent on every continent, but occurs more commonly in poorer nations owing to a lack of preventative measures. This article outlines the particular challenges in treating this disease in the developing world, including a discussion of surgical management and special situations. Otosclerosis is another surgically treatable cause of hearing loss that is found throughout the developing world. Surgeons working in these environments should be prepared to deal with advanced otosclerotic disease.
Topics: Anti-Bacterial Agents; Chronic Disease; Developing Countries; Global Health; Hearing Loss; Humans; Incidence; Otitis Media, Suppurative; Otosclerosis; Stapes Surgery
PubMed: 29525390
DOI: 10.1016/j.otc.2018.01.017 -
Otology & Neurotology : Official... Jul 2019We hypothesize that internal auditory canal (IAC) diverticula occur independent of otosclerosis as demonstrated by temporal bone histopathology.
HYPOTHESIS
We hypothesize that internal auditory canal (IAC) diverticula occur independent of otosclerosis as demonstrated by temporal bone histopathology.
BACKGROUND
Diverticula at the anterior-inferior aspect of the IAC have been described histologically in the setting of cavitary otosclerosis. Recent radiographic studies show the prevalence of IAC diverticula that is higher than what can be accounted for by cavitary otosclerosis alone.
METHODS
We examined hematoxylin and eosin temporal bone histopathology slides with otosclerosis involving the IAC. We also examined bones from normal hearing subjects with normal histologic findings. Temporal bones were included if donors were more than 18 years of age at time of death and adequate horizontal cuts were available to evaluate the area of interest.
RESULTS
IAC diverticula were found in 33 of 47 (70%) temporal bones with IAC otosclerosis and in 5 of 20 (25%) normal temporal bones. The difference in mean pure tone averages (PTA) in the normal temporal bones with (PTA 7.3 ± 7) and without (PTA 8 ± 2) diverticula was not statistically significant (p = 0.86).
CONCLUSION
IAC diverticula which have been previously demonstrated to occur in the setting of cavitary otosclerosis can also occur independent from otosclerosis. Subjects with diverticula but without other temporal bone pathology have normal hearing thresholds.
Topics: Aged; Diverticulum; Ear, Inner; Female; Hearing; Hearing Tests; Humans; Male; Otosclerosis; Temporal Bone
PubMed: 31157724
DOI: 10.1097/MAO.0000000000002256 -
American Journal of Otolaryngology 2020To review surgical outcomes of stapes surgery for otosclerosis with persistence of the stapedial artery.
PURPOSE
To review surgical outcomes of stapes surgery for otosclerosis with persistence of the stapedial artery.
MATERIALS AND METHODS
A retrospective case review of a tertiary neurotology referral center of patient with otosclerosis undergoing primary stapes surgery between 2010 and 2017 found to have a persistent stapedial artery. Stapedectomy was performed with or without cauterization of the stapedial artery. The primary outcome measures include pre- and postoperative hearing as well complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Neurologic complications, including facial nerve function, were assessed.
RESULTS
Four patients out of 853 with otosclerosis undergoing stapedectomy were found to have a persistence of the stapedial artery. Mean AC PTA was 55 dB preoperatively, and 24 dB postoperatively (p = .0041), while the ABG improved on average from 31 dB to 6 dB (p = .0014). Mean follow-up time was 32 months, and there were no significant complications. Facial nerve function was preserved in all patients (House-Brackmann grade I/VI).
CONCLUSIONS
In the case of a persistent stapedial artery, excellent hearing outcomes are achievable for otosclerosis via stapedectomy without an apparent increased risk of neurologic complication.
Topics: Aged; Arteries; Facial Nerve; Female; Hearing; Humans; Male; Middle Aged; Otosclerosis; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 32877800
DOI: 10.1016/j.amjoto.2020.102684