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Journal of Visualized Experiments : JoVE Jun 2022Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of the clinical... (Review)
Review
Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of the clinical workflow for robotic cochlear implantation using a robotic system specifically developed for a minimally invasive, direct cochlear access. The clinical workflow involves experts from various disciplines and requires training to ensure a smooth and safe procedure. The protocol briefly summarizes the history of robotic cochlear implantation. The clinical sequence is explained in detail, beginning with the assessment of patient eligibility and covering surgical preparation, preoperative planning with the special planning software, drilling of the middle ear access, intraoperative imaging to confirm the trajectory, milling of the inner ear access, insertion of the electrode array, and implant management. The steps that require special attention are discussed. As an example, the postoperative outcome of robotic cochlear implantation in a patient with advanced otosclerosis is presented. Finally, the procedure is discussed in the context of the authors' experience.
Topics: Cochlea; Cochlear Implantation; Ear, Inner; Humans; Robotic Surgical Procedures; Robotics
PubMed: 35786698
DOI: 10.3791/64047 -
Indian Journal of Occupational and... 2014Aeromedical implications of stapedotomy like rapid barometric changes and G forces are generally thought to put an end to the aviation career of an aviator. Aviation... (Review)
Review
Aeromedical implications of stapedotomy like rapid barometric changes and G forces are generally thought to put an end to the aviation career of an aviator. Aviation industry has grown tremendously in the last few decades, and aviation now is not only occupational but also recreational. The Indian Military Aviation rules state that, "Stapedectomy cases will be assessed permanently unfit for flying duties. These cases will be cautioned against flying in an unpressurised aircraft." The basis of this is the aeromedical concerns associated with stapedotomy as clinical conditions which are of minor significance on the ground may become aggravated in the air. With an ever expanding civil and military aviation industry, the number of aviators who have undergone stapedotomy has also increased. Though grounding the aircrew is the safest option, but if medical certification is denied to all, then the majority who can fly safely will also be excluded, thus denying the organization of its trained resources. This paper discusses post otosclerosis and post stapedotomy aeromedical concerns, reviews existing literature concerning post stapedotomy aviation and various post stapedotomy aviation policies.
PubMed: 25598613
DOI: 10.4103/0019-5278.146905 -
Brazilian Journal of Otorhinolaryngology 2023To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. (Review)
Review
OBJECTIVES
To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis.
METHODS
Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
RESULTS
The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI).
CONCLUSIONS
The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
Topics: Humans; Female; Otosclerosis; Brazil; Cochlear Implantation; Cochlear Implants; Stapes Surgery
PubMed: 37647735
DOI: 10.1016/j.bjorl.2023.101303 -
World Journal of Otorhinolaryngology -... Apr 2021There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In... (Review)
Review
There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.
PubMed: 33997719
DOI: 10.1016/j.wjorl.2020.09.003 -
International Archives of... Jan 2024Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy... (Review)
Review
Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. or were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies.
PubMed: 38322443
DOI: 10.1055/s-0043-1761171 -
Otology & Neurotology : Official... Jan 2019To analyse the epidemiology of otosclerosis in a British cohort collected between 2011 and 2017.
OBJECTIVE
To analyse the epidemiology of otosclerosis in a British cohort collected between 2011 and 2017.
DESIGN
Retrospective cohort study.
SETTING
Five UK ENT Departments.
PATIENTS
Patients with surgically confirmed otosclerosis.
MAIN OUTCOME MEASURES
Questionnaire data documented family history of otosclerosis, age of onset, medical history, and information on associated risk factors for 657 patients. Pre and post-surgical pure-tone audiometry was collected for 154 of these patients.
RESULTS
The age of onset, incidence of bilateral disease, tinnitus and vertigo, a higher prevalence of women (65%) than men (35%) are similar to those reported previously for otosclerosis cohorts. No association with measles infection was detected. Patients with a family history (40%) have an earlier age of onset and a higher incidence of bilateral disease and vertigo than non-familial subjects. Pedigree analysis is consistent with an autosomal dominant inheritance with reduced penetrance being apparent in 44/91 pedigrees studied. Women who associate their hearing loss with pregnancy have an earlier age of onset than those that do not (p = 6 × 10).
CONCLUSIONS
This study confirms that otosclerosis is an early adult onset disease that is more prevalent in women than men with a large minority of patients having a family history of otosclerosis. We report new evidence to support a relationship between pregnancy and otosclerosis progression in a proportion of women. In addition, this is the first study to identify differences in severity between familial and non-familial cases of otosclerosis, highlighting the possibility that more than one etiology may be involved.
Topics: Adolescent; Adult; Age of Onset; Audiometry, Pure-Tone; Child; Disease Progression; Female; Humans; Incidence; Male; Middle Aged; Otosclerosis; Prevalence; Retrospective Studies; Risk Factors; Sex Factors; Surveys and Questionnaires; United Kingdom; Young Adult
PubMed: 30540696
DOI: 10.1097/MAO.0000000000002047 -
European Archives of... Aug 2023To compare hearing outcome and surgical complications between endoscopic classic and reversal stapedotomies. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare hearing outcome and surgical complications between endoscopic classic and reversal stapedotomies.
PATIENTS AND METHODS
A prospective single blinded randomized clinical study carried out on 60 patients with otosclerosis who were randomized into two groups; each containing 30 patients. Patients in group 1 underwent endoscopic classic stapedotomy. Patients in group 2 underwent endoscopic reversal stapedotomy. Both groups were compared as regards hearing outcome and surgical complications.
RESULTS
The difference in the hearing outcome between the two groups was statistically non-significant. Post-operative closure of the air bone gap (ABG) within 10 dB was attained in 76.67% and 80% of patients in groups 1 and 2, respectively. The differences in the surgical complications between the two studied groups were statistically non-significant.
CONCLUSION
Endoscopic classic and reversal stapedotomies are comparable to each other as regards hearing outcome and surgical complications. The authors recommend further studies with relatively larger sample size.
Topics: Humans; Prospective Studies; Stapes Surgery; Ear, Middle; Hearing; Otosclerosis; Treatment Outcome; Retrospective Studies
PubMed: 36797512
DOI: 10.1007/s00405-023-07880-7 -
Ear, Nose, & Throat Journal Sep 2023Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear...
INTRODUCTION
Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results.
OBJECTIVE
The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy.
MATERIALS AND METHODS
Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy.
RESULTS
The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years).
CONCLUSIONS
The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure.
Topics: Adult; Humans; Otosclerosis; Stapes Surgery; Cochlear Implantation; Hearing; Cochlear Implants; Treatment Outcome; Retrospective Studies; Audiometry, Pure-Tone
PubMed: 33971751
DOI: 10.1177/01455613211013093 -
Medical Science Monitor : International... Apr 2019BACKGROUND Otosclerosis is a primary disease of the bony labyrinth. In the course of otosclerosis, abnormal resorption and recalcification of the endochondral layer of...
BACKGROUND Otosclerosis is a primary disease of the bony labyrinth. In the course of otosclerosis, abnormal resorption and recalcification of the endochondral layer of the temporal bone is observed. The otosclerotic process most commonly develops in the anterior part of the oval window. MATERIAL AND METHODS We analyzed stapes superstructures from 4 patients undergoing surgery for otosclerosis. The first step involved tissue assessment under a scanning electron microscope. The resulting images were analyzed in terms of morphological changes. The stapes superstructure was then divided into small "ossicles", including fragments from the closest vicinity of the stapes footplate and a fragment of the head of the stapes. This material was examined using a scanning electron microscope with a unit for chemical analysis in microareas. RESULTS Chemical analysis confirms the appearance of considerable quantities of the following elements: carbon, oxygen, potassium, and calcium, and the appearance of small quantities of sodium and magnesium. Based on a detailed analysis of the chemical composition, these fragments could represent a calcium phosphate compound from the following system: CaO-P₂O₅-H₂O. Fragments of the superstructure from the region closest to the base of the stapes demonstrated a considerably larger presence of carbon, oxygen, and nitrogen, which most likely suggests an increased metabolic process in this region. CONCLUSIONS Our analysis revealed an increased metabolic activity in the closest vicinity of the otosclerotic focus, the fissula ante fenestram. The increased metabolism correlated with the bone tissue changes seen on scanning electron microscopy.
Topics: Adult; Calcium Phosphates; Female; Humans; Middle Aged; Stapes
PubMed: 30975972
DOI: 10.12659/MSM.913635