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European Archives of... Aug 2021Even 250 years after Beethoven's birth, the irrevocable cause of his hearing impairment remains unclear despite multiple publications by different professional groups.... (Review)
Review
OBJECTIVES
Even 250 years after Beethoven's birth, the irrevocable cause of his hearing impairment remains unclear despite multiple publications by different professional groups. This study aimed to analyse the development of the most likely aetiologies during the last 100 years by a systematic review of the relevant medical literature.
METHODS
A systematic review of medical literature in PubMed, PubMed Central, and Web of Science for the period 1920-2020 was conducted. Medical publications between 1920 and 1935 were additionally searched manually by review of reference lists. Studies were eligible when a statement regarding the most likely aetiology of the hearing loss of Beethoven was the aimed objective of the publication.
RESULTS
48 publications were included. The following aetiologies were supposed: otosclerosis (n = 10), syphilis (n = 9), Paget's disease (n = 6), neural deafness (n = 5), immunopathy with inflammatory bowel disease, neural deafness with otosclerosis, sarcoidosis or lead intoxication (n = 2), and systemic lupus erythematosus, trauma, labyrinthitis or inner ear disease (n = 1). There is an ongoing effort with a mean publication frequency in this topic of 0.48/year. From 1920 to 1970, otolaryngologists were the group with the highest interest in this field (67%), whereas since 1971 most authors have belonged to non-otolaryngologic subspecialities (81%).
CONCLUSION
Over the past 100 years, otosclerosis and syphilis were predominantly supposed to be the underlying causes. The hypothesis of syphilis-although rejected for a long time-has had a remarkable revival during the past 20 years. Regarding the outcome following therapeutic intervention by cochlear implantation, the differential diagnosis of neural deafness would be relevant today.
Topics: Deafness; Famous Persons; Humans; Labyrinth Diseases; Music; Otosclerosis
PubMed: 33230590
DOI: 10.1007/s00405-020-06467-w -
Otology & Neurotology : Official... Jan 2021Concomitant otosclerosis (OTS) and superior semicircular canal dehiscence (SSCD) is a rare, but difficult-to-identify and treat diagnosis. A systematic review of the...
OBJECTIVE
Concomitant otosclerosis (OTS) and superior semicircular canal dehiscence (SSCD) is a rare, but difficult-to-identify and treat diagnosis. A systematic review of the literature was performed to analyze the diagnostic and therapeutic approaches of concurrent OTS and SSCD cases and to identify possible factors that may help in predicting the surgical outcome.
DATA SOURCES
PubMed, Scopus, Medscape, Ovid databases.
STUDY SELECTION
Studies showing diagnosis of OTS documented by audiometric test with or without associated radiological signs (computed tomography), and concomitant diagnosis of SSCD, documented at least by high-resolution computed tomography (and possibly supported by neurophysiological testing) were included. Both surgically treated and untreated patients were considered for data analysis.
DATA EXTRACTION
The general characteristics of each study were recorded, when available. Clinical, audiological, vestibular testing, surgical, and radiological data were extracted from the published case reports and series, and recorded on a database. For each case, the diagnostic steps that confirmed OTS and concomitant SSCD in the same ear were extracted.
DATA SYNTHESIS
Twelve studies were included in the review and 18 cases affected simultaneously by the 2 conditions were extracted and analyzed. Seven of 12 ears (58.3%) undergoing stapes surgery experienced a hearing improvement. In four (33.3%) cases, vestibular symptoms (with or without associated acoustic symptoms) of SSCD were unmasked or worsened by stapes surgery.
CONCLUSIONS
A reliable preoperative diagnosis of the two concomitant conditions is possible with a proper interpretation of clinical signs, audiometric, and vestibular testing, in association with the radiologic assessment. Despite that the length and the location of the dehiscence may guide the surgical decision, definitive conclusions regarding the appropriate indications for surgical treatment cannot be drawn due to the limited number of cases with adequate data reported in the literature.
Topics: Decision Making; Humans; Labyrinth Diseases; Otosclerosis; Retrospective Studies; Semicircular Canal Dehiscence; Semicircular Canals
PubMed: 33065596
DOI: 10.1097/MAO.0000000000002897 -
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 -
European Archives of... Apr 2021This meta-analysis is aimed to review and analyze all available data of intraoperative and postoperative results of endoscopic and microscopic stapes surgery. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This meta-analysis is aimed to review and analyze all available data of intraoperative and postoperative results of endoscopic and microscopic stapes surgery.
METHODS
According to the PRISMA statements checklist, this systematic review and meta-analysis were designed. Data were extracted from public databases, such as PubMed, Cochrane, Web of Science, and more. The quality of studies was evaluated using the MINORS scale. Odds ratios (ORs) and 95% CIs were estimated for binary outcome data, while the mean differences and 95% CIs were estimated for continuous data. I and χ tests were used to quantify statistical heterogeneity. If more than ten studies were included in each analysis, funnel plot would be performed to analysis publication bias.
RESULTS
Twelve studies with 620 patients were included in this meta-analysis. Primary outcomes collected in this meta-analysis included average postoperative auditory gain (APAG), postoperative air-bone gap (ABG), the rate of chorda tympani handling and bone curettage, which all showed a statistically significant difference in favor of endoscopy. While only secondary outcomes about postoperative pain and dysgeusia demonstrated a significantly reduced incidence. Furthermore, there was not any statistically significant difference on postoperative dizziness and average operative time between endoscopy and microscopy.
CONCLUSION
Although there is a need for high-quality pooled data in the future, a consistently superior effect of the endoscopic group was still shown in terms of total effectiveness, when compared to the microscopic group. We have reasons to support the application of endoscopy in stapes surgery. The future of ESS, we believe, is blazing bright.
Topics: Endoscopy; Humans; Microscopy; Operative Time; Otosclerosis; Reference Standards; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 32648030
DOI: 10.1007/s00405-020-06132-2 -
Otology & Neurotology : Official... Sep 2020The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed.
DATA SOURCES
A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research.
STUDY SELECTION
Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis.
DATA EXTRACTION
Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool.
DATA SYNTHESIS
Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68-43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46-10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57-52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3-43%) and those with otosclerosis had an overall rate of 26% (range, 6.25-75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation.
CONCLUSION
Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.
Topics: Cochlea; Cochlear Implantation; Cochlear Implants; Facial Nerve; Hearing Tests; Humans; Otosclerosis
PubMed: 32558747
DOI: 10.1097/MAO.0000000000002693 -
European Archives of... Jan 2021Stapes surgery is the gold standard surgical treatment nowadays for otosclerosis. Several controversies on the procedure have been reported; surgical techniques for most... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Stapes surgery is the gold standard surgical treatment nowadays for otosclerosis. Several controversies on the procedure have been reported; surgical techniques for most favorable outcomes are still on discussion. The objective of this study is to present an update of evidence-based medicine concerning the utilization of lasers and drilling for footplate fenestration during stapedotomy surgery. A systematic review and meta-analysis were conducted.
MATERIALS AND METHODS
Publications in English in the last 5 years were searched in the PubMed/MEDLINE database and were systematically reviewed. A total of three articles were included according to the inclusion criteria, obtaining a total of 1531 patients managed surgically for otosclerosis, using laser or drill for footplate fenestration. Data were systematically extracted and hearing results were compared in a meta-analysis.
RESULTS
For the drill group, a total of 978 patients were retrieved and data were obtained as follows: mean age was 50 years old; the female proportion was 62%; mean preoperative air-bone gap (ABG) of 28 dB; mean postoperative ABG of 8 dB; mean ABG improvement of 20 dB; an ABG closure rate to < 10 dB of 74%. For the laser group, a total of 553 patients were retrieved, data were obtained as follows: mean age was 47 years old; the female proportion was 63%; preoperative ABG of 26 dB; postoperative ABG of 8 dB; mean ABG improvement of 18 dB; an ABG closure rate to < 10 dB of 72%.
CONCLUSION
The results from this study reveal that in regard to postoperative hearing results, surgical outcomes are comparable, and there is no statistically significant difference between the utilization of drills and lasers as a surgical instrument for the fenestration of the stapes footplate during stapedotomy surgery.
Topics: Audiometry, Pure-Tone; Bone Conduction; Female; Fenestration, Labyrinth; Hearing; Humans; Lasers; Middle Aged; Otosclerosis; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 32535861
DOI: 10.1007/s00405-020-06117-1 -
The Journal of Laryngology and Otology May 2020To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery. (Comparative Study)
Comparative Study
OBJECTIVES
To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery.
METHODS
Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results.
RESULTS
Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques.
CONCLUSION
Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Endoscopy; Female; Hearing Loss; Humans; Male; Microsurgery; Middle Aged; Operative Time; Otosclerosis; Postoperative Complications; Stapes Surgery; Treatment Outcome; Young Adult
PubMed: 32308176
DOI: 10.1017/S0022215120000821 -
Otology & Neurotology : Official... Mar 2020To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative...
Correlation Between Electrocochleographic Changes During Surgery and Hearing Outcome in Cochlear Implant Recipients: A Case Report and Systematic Review of the Literature.
OBJECTIVE
To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative hearing loss.
METHODS
ECochG, radiological, and audiological data were collected prospectively in a cochlear implant recipient with otosclerosis and assumed cochlear trauma during electrode insertion. A systematic review was conducted within PubMed-NCBI, EMBASE, and the Cochrane Library using the terms "Cochlear implant" and "Electrocochleography." Original studies that evaluated intraoperative ECochG responses and postoperative hearing loss were selected and analyzed.
RESULTS
The case report revealed a drop of intra- and extracochlear ECochG signals during electrode insertion. The postoperative computed tomography scan suggested a scalar dislocation. There was no measurable hearing 4 weeks after surgery. Within the database search, nine articles met the inclusion criteria. All were case series reports (range from 2 to 36 subjects) with a total of 173 subjects. Due to the heterogeneous data, a meta-analysis was unfeasible.
CONCLUSIONS
In concordance with some findings in the literature, the presented case report suggests that a drop of intra- and extracochlear ECochG signals during the insertion of the electrode array is associated with cochlear trauma and postoperative hearing loss in some cases. However, the literature is inconclusive regarding the correlation between intraoperative changes of the ECochG signals and postoperative hearing preservation. More studies investigating the correlation are needed to provide sufficient data.
Topics: Audiometry, Evoked Response; Cochlea; Cochlear Implantation; Cochlear Implants; Hearing; Humans
PubMed: 31834213
DOI: 10.1097/MAO.0000000000002506 -
The Laryngoscope Aug 2020Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter.
METHODS
We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I and χ tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis.
RESULTS
Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89).
CONCLUSIONS
Endoscopic stapes surgery is a valid alternative to the microscope.
LEVEL OF EVIDENCE
2a Laryngoscope, 130: 2019-2027, 2020.
Topics: Endoscopy; Humans; Microsurgery; Stapes Surgery; Treatment Outcome
PubMed: 31714605
DOI: 10.1002/lary.28353 -
European Archives of... Dec 2018To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery.
METHODS
MEDLINE, the Cochrane Library and Web of Science databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic stapedotomy in patients with otosclerosis or congenital stapedial fixation were included. Achievement of a postoperative air-bone gap ≤ 10 decibel was the primary outcome. Secondary outcomes were postoperative dysgeusia, scutum drilling and operation time. In case of homogenous, processable data (I < 60%) a meta-analysis was performed. Odds ratio (OR) and Chi-square test were used to compare the two methods.
RESULTS
Seven studies met the inclusion criteria. The OR analysis showed no significant differences between the two methods (OR 1.41, 95%CI [0.84, 2.38]), but goodness-of-fit analysis showed a correlation of endoscopic stapedotomy with normal hearing restoration (p = 0.00). Dysgeusia and scutum drilling took place significantly less often in the endoscopy group (OR 0.31, 95%CI [0.14, 0.69], p = 0.00 and OR 0.01, 95%CI [0.00, 0.07], p = 0.00 respectively).
CONCLUSION
As of yet, endoscopic surgery does not seem to confer benefit on audiological improvement comparing to conventional microscopic, however, it leads to less scutum drilling and fewer postoperative dysgeusia cases. High-quality, large-sample studies need to be performed in the future.
Topics: Dysgeusia; Endoscopy; Humans; Microscopy; Operative Time; Otosclerosis; Postoperative Complications; Stapes Surgery
PubMed: 30327907
DOI: 10.1007/s00405-018-5166-2