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Acta Oto-laryngologica 2022Thulium laser use in stapedotomy surgery is usually associated with many doubts regarding the thermal effect on the vestibular area and the production of acoustic shock... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Thulium laser use in stapedotomy surgery is usually associated with many doubts regarding the thermal effect on the vestibular area and the production of acoustic shock waves, which may result in permanent complications.
OBJECTIVES
We aimed to evaluate the efficacy and safety of the Thulium laser use in stapedotomy and its long-term effects on the clinical and audiological results.
MATERIAL AND METHODS
It was a retrospective randomized case-series study. We included 148 otosclerosis patients. They were divided randomly into two groups; group A (multiple shots) included 62 patients and group B (one shot with a manual perforator) included 86 patients.
RESULTS
There was a statistically significant improvement of the ABG in both groups. ABG closure (<10 dB) occurred in 87.1% of patients in group A, and 89.5% of patients in group B. Intraoperative complications were more in group B (-value = 0.038). The postoperative complications were more in group A (-value = .017).
CONCLUSIONS
According to our experience on a relatively large number of cases, the Thulium laser is a safe tool to be used in stapedotomy either in multiple shots or one shot with a manual perforator. It improved functional hearing efficiently without showing signs of inner ear impairment.
Topics: Humans; Laser Therapy; Lasers; Otosclerosis; Retrospective Studies; Stapes Surgery; Thulium; Treatment Outcome
PubMed: 35468299
DOI: 10.1080/00016489.2022.2048071 -
The Journal of Laryngology and Otology Mar 2022
Topics: Anosmia; COVID-19; Cholesteatoma, Middle Ear; Female; Humans; Maxillary Sinus; Neoplasms; Otosclerosis; Pregnancy; Therapeutic Irrigation
PubMed: 35285793
DOI: 10.1017/S0022215122000688 -
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 -
International Archives of... Jul 2022Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. To assess the prevalence of tinnitus in otosclerosis, its main...
Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.
PubMed: 35846815
DOI: 10.1055/s-0041-1739967 -
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 -
Otolaryngologic Clinics of North America Aug 2020The search for an effective medication that will eliminate tinnitus has a long history. Currently, no drugs exist that universally cure tinnitus. Pharmacologic... (Review)
Review
The search for an effective medication that will eliminate tinnitus has a long history. Currently, no drugs exist that universally cure tinnitus. Pharmacologic interventions that have been investigated can be divided into those that attempt to eliminate the perception of tinnitus, and those that are designed to treat the negative comorbidities associated with tinnitus, thereby mitigating tinnitus' negative impact on quality of life. A third category of drugs can also be considered that addresses an identified pathologic condition that has tinnitus as an associated symptom (for example, Meniere's disease, otosclerosis, migraine-associated vertigo). This third category is not addressed.
Topics: Anxiety; Depression; Humans; Meniere Disease; Neurotransmitter Agents; Otosclerosis; Psychoacoustics; Randomized Controlled Trials as Topic; Tinnitus; Vertigo
PubMed: 32334873
DOI: 10.1016/j.otc.2020.03.009 -
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 -
Clinical Otolaryngology : Official... Nov 2022To review the role of the endoscope in cochlear implantation (CI). (Review)
Review
OBJECTIVE
To review the role of the endoscope in cochlear implantation (CI).
METHODS
MEDLINE, ScienceDirect, Google Scholar and the Cochrane Library databases, as well as other sources, were searched by two independent reviewers. Studies including patients undergoing either exclusively endoscopic or endoscopically assisted CI were eligible for inclusion. Endoscopic CI approaches and postoperative complications were the primary outcomes. Secondary endpoints included the degree of round window (RW) microscopic visualisation according to St Thomas' Hospital classification and type of cochleostomy for electrode insertion in the scala tympani (ST).
RESULTS
Fourteen studies met the inclusion criteria comprising 191 endoscopic or endoscopically assisted CI cases. The endoscope was used for better visualisation of the RW across all included studies, facilitated the insertion of the electrode in the ST and spared a mastoidectomy in a number of cases. No facial nerve palsy was reported in any of the studies. The most common complication was external auditory canal/tympanic membrane tear followed by chorda tympani injury.
CONCLUSION
The microscopic CI approach is still the gold standard. The endoscope facilitates the recognition of the RW area and leads to successful and safe implantation, particularly in difficult anatomical scenarios, ear malformations and advanced otosclerosis. Endoscopically assisted CI procedures offer the opportunity to avoid a posterior tympanotomy and reduce the risk of facial nerve injury. To date, the lack of long-term data does not permit the widespread adoption of completely endoscopic CI procedures without a mastoidectomy.
Topics: Cochlear Implantation; Cochlear Implants; Endoscopes; Humans; Round Window, Ear; Scala Tympani
PubMed: 34971491
DOI: 10.1111/coa.13909