-
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 -
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 -
Cureus May 2020Introduction Otosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at...
Introduction Otosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at the level of the oval window. The solution to this condition is to reestablish this mechanism back to normal via the ossicular chain to the inner ear. The aim of stapes surgery is to improve the hearing level to thresholds appropriate enough to obviate the need for hearing aid. The hearing improvement achieved after surgery often lasts for many years. The purpose of the current study was to review our experience and find out the rate of success related to hearing outcomes after stapedotomy. Methods The patients who were operated for otosclerosis between January 2000 and December 2010 at Aga Khan University Hospital, Karachi, Pakistan were included in the study. The charts were reviewed to collect clinical data regarding stapes surgery. The values of speech reception threshold (SRT) were recorded, and the preoperative and postoperative means were compared with a t-test. The bone conduction (BC) and air conduction (AC) thresholds were evaluated at 0.5 kHz, 1.0 kHz, 2.0 kHz, and 3.0 kHz. The preoperative and postoperative means of air-bone gap (AB-gap) were compared with a t-test. The descriptive frequency was calculated to evaluate postoperative AB-gap in individual patients; patients were grouped with a difference of 10 dB of AB-gap. The SPSS Statistics software (IBM, Armonk, NY) was used for statistical analysis. Results A total of 46 patients were included in the study. There were 15 males and 31 females. The mean age was 35 years (range: 20-56). Thirty-three patients had bilateral otosclerosis; two patients had surgery for both ears, taking the total number of ears operated to 48. The mean preoperative AB-gap was 39, while the mean postoperative AB-gap was 11. The means were compared with a t-test and a p-value of <0.05 was considered significant. The means of preoperative and postoperative SRT were 56.25 and 24.27 respectively. Both means were compared with a t-test, and a p-value of <0.05 was considred significant. Postoperatively, 34 ears had AB-gap of 10 dB (70.8%), 11 (22.9%) had within 20 dB, and three (6.3%) had within 30 dB. Conclusions The success rate related to hearing outcomes in patients operated for otosclerosis was excellent and comparable to that found in the current literature. The wide AB-gap noticed in the majority of our patients may represent a delayed presentation to otolaryngologists, which requires further evaluation.
PubMed: 32499972
DOI: 10.7759/cureus.7927 -
Indian Journal of Otolaryngology and... Sep 2022The aim of this study was to measure cone beam computed tomography (CBCT) derived bone density of 6 anatomic points around the otic capsule in preoperative assessment of...
The aim of this study was to measure cone beam computed tomography (CBCT) derived bone density of 6 anatomic points around the otic capsule in preoperative assessment of patients with clinically suspected otosclerosis, and to compare these densities with control group. CBCT images of 21 patients (34 ears, the otosclerosis group) with surgically confirmed otosclerosis and 26 patients (52 normal ears, the control group) were evaluated in this prospective study. Six regions of interest (ROI) were set manually around the otic capsule with the slice thickness of 0.3 mm. The mean CBCT bone density these regions were measured and compared in the case and control groups. In the case group, the mean CBCT bone density at the fissula ante fenestram (FAF) was significantly lower than the control group. Moreover, at the 4 points of the other ROIs (3-6) CBCT bone densities were significantly lower in the case group compared to the control group ( < 0.01). In this group, among 13 bilateral otosclerosis, 22 ears had conductive hearing loss (CHL), 4 ears had mixed hearing loss (MHL) and among 8 unilateral otosclerosis, 5 ears had CHL, 3 ears had MHL. Our study showed the mean CBCT bone density of ROIs 1 and 6 were correlated with the average air-bone gap in the bilateral and unilateral otosclerosis group, respectively. Quantitative evaluation of CBCT with a slice thickness of 0.3 mm can be used as a suitable tool for diagnosis and follow-up of otosclerosis in temporal bone.
PubMed: 36213485
DOI: 10.1007/s12070-021-02502-2 -
JAMA Network Open Feb 2022Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness...
IMPORTANCE
Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness and budget impact of otosclerosis treatments have never been studied in Europe.
OBJECTIVES
To compare the estimated mean costs per patient over 10 years of surgery vs hearing aids for the treatment of otosclerosis and to estimate the budget impact of an increase in the proportion of patients receiving surgical treatment.
DESIGN, SETTING, AND PARTICIPANTS
This economic evaluation analyzed French and European epidemiological data on the surgical management of symptomatic otosclerosis and compared them with data from the literature to build economic models. The analysis was conducted in January 2021.
EXPOSURES
Two care pathways were considered in the treatment of otosclerosis, either hearing aid or surgery.
MAIN OUTCOMES AND MEASURES
Costs were studied over 10 years using Markov models of the 2 care pathways (hearing aid vs surgery). The budget impact analysis was performed over 5 and 10 years, assuming a 1-percentage point yearly increase in the proportion of patients receiving surgical treatment.
RESULTS
Over 10 years, the estimated mean cost per patient was significantly lower in the surgery group compared with the hearing aid group (€3446.9 vs €6088.4; mean difference, -€2641.5; 95% CI -€4064.8 to -€1379.4 [US $3913.4 vs US $6912.4; mean difference, -US $2999.0; 95% CI, -US $4614.9 to -US $1566.1]). Increasing surgical treatment by 1 percentage point per year for 10 years would lead to overall savings of €1 762 304 (US $2 000 798) in France, with an increase of €1 322 920 (US $1 501 952) at 10 years for the public health insurance system and a decrease of €3 085 224 (US $3 502 750) at 10 years for patients and private health insurers. Sensitivity analyses showed that these results were robust.
CONCLUSIONS AND RELEVANCE
These results suggest that in France, treating otosclerosis surgically is slightly less expensive over 10 years than using hearing aids, when considering all payers. The proposed models developed in this study could be adjusted to perform the same analysis in other countries.
Topics: Cost-Benefit Analysis; Europe; Hearing Aids; Humans; Markov Chains; Models, Economic; Otologic Surgical Procedures; Otosclerosis
PubMed: 35175343
DOI: 10.1001/jamanetworkopen.2021.48932 -
BMJ Case Reports Apr 2016Otosclerosis in childhood and adolescence or juvenile otosclerosis is a rare disorder resulting in conductive hearing loss. A 9-year-old boy presented to our clinic,... (Review)
Review
Otosclerosis in childhood and adolescence or juvenile otosclerosis is a rare disorder resulting in conductive hearing loss. A 9-year-old boy presented to our clinic, suffering from moderate hearing loss. According to his parents, his hearing acuity had progressively deteriorated over the past 2 years. Otoscopy and tympanometry revealed bilateral secretory otitis media and the patient underwent bilateral grommet insertion. However, he continued to report of hearing loss and a right exploratory tympanotomy was performed. Stapedial fixation was confirmed, being compatible with juvenile otosclerosis, and we proceeded to a right stapedotomy. One year later, follow-up showed satisfactory outcome with an air-bone gap closure to 10 dB. Juvenile otosclerosis with the coexistence of persistent secretory otitis media can be overlooked. Affected children from 9 years of age are strongly motivated to undergo stapes surgery for juvenile otosclerosis, following parental consent.
Topics: Child; Hearing Loss, Conductive; Humans; Male; Otitis Media with Effusion; Otosclerosis; Stapes Surgery
PubMed: 27084899
DOI: 10.1136/bcr-2015-214232 -
Journal of Audiology & Otology Apr 2015Mass and stiffness affect on the peculiar characteristics of transmission of the middle ear and the distinctive behavior of the cochlear mechanics. Applying the... (Review)
Review
Mass and stiffness affect on the peculiar characteristics of transmission of the middle ear and the distinctive behavior of the cochlear mechanics. Applying the principle of the mass and stiffness, the band-pass characteristic transfer function of the middle ear has been explained. The greatest transfer function of the middle ear, approximately 24-29 dB, is observed at 1-2 kHz in both cat and human species. However, at lower frequencies, the transfer function was disturbed by the stiffness of the middle ear primarily due to middle ear cavity. At higher frequencies, the transfer function was disturbed by the stiffness of the middle ear primarily due to middle ear bones. Several examples, such as an acoustic reflex, otitis media, and otosclerosis are discussed. For understanding the traveling wave of the basilar membrane, different place tuning at certain stimulus frequencies, contrastingly shaped basilar membrane to the cochlear duct, and the structural and physical characteristics of the whole cochlear partition were reviewed in terms of changing width, mass, and stiffness from the base to apex. Being about ten times wider, more massive, and one hundredfold stiffer at the base than the apex, the nature of the cochlear partition to absorb high-frequency energy changes in fluid pressure declines toward the apex. Consequently, at the base of the cochlea, high frequencies stimuli are decoded while low frequencies stimuli are decoded at the apex of the cochlea. Due to these characteristics of the cochlear partition, the direction of the traveling wave was also proved to be in the fashion of base-to-apex always.
PubMed: 26185784
DOI: 10.7874/jao.2015.19.1.1 -
Ear, Nose, & Throat Journal Mar 2022This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is...
This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively. Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters. The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant ( < .001). From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time.
PubMed: 35259947
DOI: 10.1177/01455613221078183 -
Ear, Nose, & Throat Journal Apr 2023We report resolution of right-sided pulsatile tinnitus in a 44-year-old male who underwent stapedectomy for fenestral otosclerosis. Initial workup revealed a mixed...
We report resolution of right-sided pulsatile tinnitus in a 44-year-old male who underwent stapedectomy for fenestral otosclerosis. Initial workup revealed a mixed hearing loss and absent stapedial reflexes consistent with ossicular fixation. CT angiography demonstrated near complete stenosis of the left-sided transverse and sigmoid sinuses and dominant contralateral venous outflow. We hypothesized that the dominant right cerebral venous outflow tract created turbulent flow that was conducted to cochlea. Successful stapedectomy was performed, and the pulsatile tinnitus resolved. This case report demonstrates evidence that the sound of turbulent blood flow can be conducted through bone and an instance where the perception of vascular tinnitus was eliminated with stapedectomy.
PubMed: 37082922
DOI: 10.1177/01455613231166581 -
Frontiers in Molecular Neuroscience 2023Hearing loss is one of the 10 leading causes of disability worldwide. No drug therapies are currently available to protect or restore hearing. Inner ear auditory hair...
Hearing loss is one of the 10 leading causes of disability worldwide. No drug therapies are currently available to protect or restore hearing. Inner ear auditory hair cells and the blood-labyrinth barrier (BLB) are critical for normal hearing, and the BLB between the systemic circulation and stria vascularis is crucial for maintaining cochlear and vestibular homeostasis. BLB defects are associated with inner ear diseases that lead to hearing loss, including vascular malformations, inflammation, and Meniere's disease (MD). Antibodies against proteins in the inner ear and cytokines in the cochlea, including IL-1α, TNF-α, and NF-kβ, are detected in the blood of more than half of MD patients. There is also emerging evidence of inner ear inflammation in some diseases, including MD, progressive sensorineural hearing loss, otosclerosis, and sudden deafness. Here, we examined the effects of TNF-α, IL6, and LPS on human stria vascularis-derived primary endothelial cells cultured together with pericytes in a Transwell system. By measuring trans-endothelial electrical resistance, we found that TNF-α causes the most significant disruption of the endothelial barrier. IL6 had a moderate influence on the barrier, whereas LPS had a minimal impact on barrier integrity. The prominent effect of TNF-α on the barrier was confirmed in the expression of the major junctional genes responsible for forming the tight endothelial monolayer, the decreased expression of and . We further tested permeability using 2 μg of daptomycin (1,619 Da), which does not pass the BLB under normal conditions, by measuring its passage through the barrier by HPLC. Treatment with TNF-α resulted in higher permeability in treated samples compared to controls. LPS-treated cells behaved similarly to the untreated cells and did not show differences in permeability compared to control. The endothelial damage caused by TNF-α was confirmed by decreased expression of an essential endothelial proteoglycan, syndecan1. These results allowed us to create an inflammatory environment model that increased BLB permeability in culture and mimicked an inflammatory state within the stria vascularis.
PubMed: 37808472
DOI: 10.3389/fnmol.2023.1243370