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Medicina (Kaunas, Lithuania) May 2024Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the...
Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the surgical steps in stapedotomy impacts vestibular function and hearing improvement. A cohort of 123 patients underwent either classic or reverse stapedotomy procedures utilizing a fiber-optic argon laser. Audiological assessments, following the guidelines of the Committee on Hearing and Equilibrium, were conducted, including pure tone average, air-bone (AB) gap, overclosure, and AB gap closure. Vestibular evaluation involved pre- and postoperative comparison of rotatory test parameters, including frequency, amplitude, and slow phase velocity of nystagmus. The study demonstrated an overall median overclosure of 3.3 (3.3, 5.0) dB and a mean AB gap closure of 20.3 ± 8.8 dB. Postoperative median AB gap was 7.5 (7.5, 11.3) dB in the reverse stapedotomy group and 10.0 (10.0, 12.5) dB in the classic stapedotomy group. While overclosure and AB gap closure were marginally superior in the reverse stapedotomy group, these differences did not reach statistical significance. No significant disparities were observed in the frequency, slow phase velocity, or amplitude of nystagmus in the rotational test. Although not always possible, reverse stapedotomy proved to be a safe surgical technique regarding postoperative outcomes. Its adoption may mitigate risks associated with floating footplate, sensorineural hearing loss, and incus luxation/subluxation, while facilitating the learning curve for less experienced ear surgeons.
Topics: Humans; Stapes Surgery; Male; Female; Middle Aged; Adult; Otosclerosis; Audiometry; Cohort Studies; Treatment Outcome; Audiometry, Pure-Tone; Aged; Vestibular Function Tests
PubMed: 38792986
DOI: 10.3390/medicina60050803 -
European Archives of... Jul 2024The diagnosis and management of Superior Canal Dehiscence Syndrome (SCDS) with concomitant otosclerosis can be a challenge. Otosclerosis can mask SCDS symptoms and...
OBJECTIVE
The diagnosis and management of Superior Canal Dehiscence Syndrome (SCDS) with concomitant otosclerosis can be a challenge. Otosclerosis can mask SCDS symptoms and stapes surgery may reveal or exacerbate vestibular symptoms. Our aim is to present four cases of SCDS with concomitant otosclerosis and thereby informing the reader about the possibility of this dual occurrence and its implications for treatment.
CASES
Four patients with SCDS and concomitant otosclerosis are presented. Two patients underwent surgical treatment for both SCDS and otosclerosis and two patients opted for conservative management.
OUTCOMES
The main differences between surgically and non-surgically treated cases are the presence of autophony and pressure-induced vertigo and a more severe experience of symptoms in surgically treated cases. Surgically treated cases achieved a sizeable reduction in postoperative air-bone gap and resolution of vestibular symptoms.
CONCLUSION
The subjective severity of symptoms in combination with shared decision-making is key in determining the appropriate treatment plan for SCDS and concomitant otosclerosis.
Topics: Humans; Otosclerosis; Middle Aged; Female; Male; Semicircular Canal Dehiscence; Stapes Surgery; Adult; Clinical Decision-Making; Semicircular Canals; Aged
PubMed: 38780629
DOI: 10.1007/s00405-024-08679-w -
Audiology & Neuro-otology May 2024Otosclerosis is a bone disorder affecting the labyrinthine capsule that leads to conductive and occasionally sensorineural hearing loss. The etiology of otosclerosis...
INTRODUCTION
Otosclerosis is a bone disorder affecting the labyrinthine capsule that leads to conductive and occasionally sensorineural hearing loss. The etiology of otosclerosis remains unknown; factors such as infection, hormones, inflammation, genetics, and autoimmunity have been discussed. Treatment consists primarily of surgical stapes replacement and cochlear implantation. High-resolution computed tomography is routinely used to visualize bone pathology. In the present study, we used synchrotron radiation phase-contrast imaging (SR-PCI) to examine otosclerosis plaques in a temporal bone for the first time. The primary aim was to study their three-dimensional (3D) outline, vascular interrelationships, and connections to the middle ear.
METHODS
A donated ear from a patient with otosclerosis who had undergone partial stapedectomy with the insertion of a stapes wire prosthesis was investigated using SR-PCI and compared with a control ear. Otosclerotic lesions were 3D rendered using the composite with shading technique. Scalar opacity and color mapping were adjusted to display volume properties with the removal of bones to enhance surfaces. Vascular bone channels were segmented, and the communications between lesions and the middle ear were established.
RESULTS
Fenestral, cochlear, meatal, and vestibular lesions were outlined three-dimensionally. Vascular bone channels were found to be frequently connected to the middle ear mucosa, perilabyrinthine air spaces, and facial nerve vessels. Round window lesions partly embedded the cochlear aqueduct which was pathologically narrowed, while the inferior cochlear vein was significantly dilated in its proximal part.
CONCLUSION
Otosclerotic/otospongiotic lesions were imaged for the first time using SR-PCI and 3D rendering. The presence of shunts and abnormal vascular connections to the labyrinth appeared to result in hyper-vascularization, overloading the venous system, and leading to sensorineural hearing loss. We speculate about possible local treatments to alleviate the impact of such critical lesions on the labyrinthine microcirculation.
PubMed: 38763131
DOI: 10.1159/000539422 -
Laryngoscope Investigative... Jun 2024Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative...
BACKGROUND
Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative dizziness has been associated with stapedotomy. In 1981, intratympanic dexamethasone was utilized to manage inner ear disorders like tinnitus and acute sensorineural hearing loss. However, there is much uncertainty regarding the effect and safety of topical steroid therapy in the middle ear during stapedotomy. In the present study, we assessed the effect of topical steroid therapy during stapedotomy on postoperative dizziness.
METHODS
Otosclerosis patients eligible for stapedotomy were randomly divided into two groups based on dexamethasone administration or placebo. Audiometric and tympanometry results were observed and recorded for the involved frequencies. The Dizziness Handicap Inventory was used to quantify patient perceptions of dizziness and balance issues. Audiometry and dizziness assessments were repeated at discharge and 4 months after the operation.
RESULTS
The study comprised 72 otosclerosis patients undergoing stapedotomy. At discharge, the intervention group showed a significant reduction in the incidence of dizziness compared to the placebo group. However, in the 4-month follow-up after the operation, both groups experienced a decrease in dizziness incidence, with no significant difference between them. There was also no significant difference in audiometric levels between the two groups. Interestingly, the intervention group had a significantly lower need for systemic anti-dizziness drugs after surgery compared to the control group.
CONCLUSION
Topical dexamethasone during stapedotomy effectively minimizes dizziness at discharge and reduces the need for postoperative anti-dizziness medication.
LEVEL OF EVIDENCE
2.
PubMed: 38736941
DOI: 10.1002/lio2.1257 -
Otology & Neurotology : Official... Jun 2024To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to...
OBJECTIVES
To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to facilitate the identification of the round window membrane and the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.
STUDY DESIGN
Retrospective case-series study.
SETTING
Tertiary academic CI center.
PATIENTS AND METHODS
This study was conducted on patients with far advanced otosclerosis who underwent endoscopic-assisted CI between January 2010 and June 2020 at the same CI center. The minimum follow-up period was 2 years after surgery.
RESULTS
Fourteen patients were included in the study. Ten patients had undergone a previous stapedotomy. Electrode insertion in the scala tympani was successfully accomplished in all cases included in the study. There was a statistically significant improvement in pure-tone average and speech discrimination scores in all cases of the study group (p < 0.0001). There were no statistically significant differences in postoperative pure-tone average or speech discrimination scores between cases with and without cochlear ossification or between cases with and without a previous stapedotomy (p > 0.05).
CONCLUSION
Endoscopic-assisted CI is an effective option for hearing restoration in patients with far advanced otosclerosis. Otoendoscopy can facilitate visualization and access to the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.
Topics: Humans; Otosclerosis; Male; Female; Retrospective Studies; Middle Aged; Cochlear Implantation; Endoscopy; Adult; Aged; Treatment Outcome
PubMed: 38728555
DOI: 10.1097/MAO.0000000000004192 -
Otology & Neurotology : Official... Jun 2024To examine patient preference after stapedotomy versus cochlear implantation in a unique case of a patient with symmetrical profound mixed hearing loss and similar...
OBJECTIVE
To examine patient preference after stapedotomy versus cochlear implantation in a unique case of a patient with symmetrical profound mixed hearing loss and similar postoperative speech perception improvement.
PATIENTS
An adult patient with bilateral symmetrical far advanced otosclerosis, with profound mixed hearing loss.
INTERVENTION
Stapedotomy in the left ear, cochlear implantation in the right ear.
MAIN OUTCOME MEASURE
Performance on behavioral audiometry, and subjective report of hearing and intervention preference.
RESULTS
A patient successfully underwent left stapedotomy and subsequent cochlear implantation on the right side, per patient preference. Preoperative audiometric characteristics were similar between ears (pure-tone average [PTA] [R: 114; L: 113 dB]; word recognition score [WRS]: 22%). Postprocedural audiometry demonstrated significant improvement after stapedotomy (PTA: 59 dB, WRS: 75%) and from cochlear implant (PTA: 20 dB, WRS: 60%). The patient subjectively reported a preference for the cochlear implant ear despite having substantial gains from stapedotomy. A nuanced discussion highlighting potentially overlooked benefits of cochlear implants in far advanced otosclerosis is conducted.
CONCLUSION
In comparison with stapedotomy and hearing aids, cochlear implantation generally permits greater access to sound among patients with far advanced otosclerosis. Though the cochlear implant literature mainly focuses on speech perception outcomes, an underappreciated benefit of cochlear implantation is the high likelihood of achieving "normal" sound levels across the audiogram.
Topics: Humans; Otosclerosis; Stapes Surgery; Cochlear Implantation; Speech Perception; Treatment Outcome; Male; Middle Aged; Hearing Loss, Mixed Conductive-Sensorineural; Audiometry, Pure-Tone; Patient Preference; Female; Adult
PubMed: 38728553
DOI: 10.1097/MAO.0000000000004197 -
Journal of Personalized Medicine Apr 2024(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can...
(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.
PubMed: 38673055
DOI: 10.3390/jpm14040428 -
Audiology Research Apr 2024We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable...
Otic Capsule Dehiscences Simulating Other Inner Ear Diseases: Characterization, Clinical Profile, and Follow-Up-Is Ménière's Disease the Sole Cause of Vertigo and Fluctuating Hearing Loss?
INTRODUCTION
We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable resemblance to Ménière's disease and otosclerosis. The occurrence of these cases in such a short period has prompted a review of the underlying causes of its development. Understanding the pathophysiology of third mobile window syndrome and considering these entities in the differential diagnosis of conditions presenting with vertigo and hearing loss with slight air-bone gaps is essential for comprehending this group of pathologies.
MATERIALS AND METHODS
A descriptive retrospective cohort study of six cases diagnosed at a tertiary center. All of them went through auditive and vestibular examinations before and after a therapeutic strategy was performed.
RESULTS
Out of 84 cases of dehiscences described in our center during the period from 2014 to 2024, 78 belonged to superior semicircular canal dehiscence, while 6 were other otic capsule dehiscences. Among these six patients with a mean age of 47.17 years (range: 18-73), all had some form of otic capsule dehiscence with auditory and/or vestibular repercussions, measured through hearing and vestibular tests, with abnormalities in the results in five out of six patients. Two of them were diagnosed with Ménière's disease (MD). Another two had cochleo-vestibular hydrops without meeting the diagnostic criteria for MD. In two cases, the otic capsule dehiscence diagnosis resulted from an intraoperative complication due to a gusher phenomenon, while in one case, it was an accidental radiological finding. All responded well to the proposed treatment, whether medical or surgical, if needed.
CONCLUSIONS
Otic capsule dehiscences are relatively new and unfamiliar entities that should be considered when faced with cases clinically suggestive of Ménière's disease, with discrepancies in complementary tests or a poor response to treatment. While high-sensitivity and specificity audiovestibular tests exist, completing the study with imaging, especially petrous bone CT scans, is necessary to locate and characterize the otic capsule defect responsible for the clinical presentation.
PubMed: 38666903
DOI: 10.3390/audiolres14020032 -
Acta Oto-laryngologica Mar 2024Stapes footplate thickness measurement using ultra-high-resolution CT has been described only in the lateral semicircular canal plane. The purpose of this study was to...
Measurement of stapes footplate thickness using ultra-high-resolution computed tomography: stapes axial plane correlates better with otosclerosis than lateral semicircular canal plane.
BACKGROUND, AIMS
Stapes footplate thickness measurement using ultra-high-resolution CT has been described only in the lateral semicircular canal plane. The purpose of this study was to compare stapes footplate thickness between the lateral semicircular canal and stapes axial planes in patients with otosclerosis compared to controls.
MATERIAL AND METHODS
We performed a retrospective single-center study of patients undergoing high-resolution temporal bone CT. Two radiologists measured stapes footplate thickness in both the lateral semicircular canal and stapes axial planes.
RESULTS
Between February 2020 and October 2022, we collected 81 ears from 49 patients (75% of women; mean age 51.22 ± 16.6 years, 17 otosclerosis, and 64 controls). In the stapes axial plane, there was a significant anterior thickening in otosclerosis patients (Reader 1: 0.52 ± 0.12 [0.3-0.7] vs. 0.41 ± 0.08 [0.3-0.6], = 0.001; Reader 2: 0.54 ± 0.06 [0.5-0.7] vs. 0.39 ± 0.08 [0.2-0.6], < 0.001) compared to controls. These differences were not significant using the lateral semicircular canal plane.
CONCLUSION
The stapes footplate was thickened at its AC in otosclerosis patients using only the stapes axial plane.
SIGNIFICANCE
We propose to use the stapes axial plane instead of the lateral semicircular canal plane when analyzing the stapes.
Topics: Humans; Otosclerosis; Female; Middle Aged; Male; Retrospective Studies; Semicircular Canals; Stapes; Tomography, X-Ray Computed; Adult; Aged; Temporal Bone; Case-Control Studies
PubMed: 38662875
DOI: 10.1080/00016489.2024.2340083 -
Heliyon Apr 2024This study aimed to develop an automated detection schema for otosclerosis with interpretable deep learning using temporal bone computed tomography images.
OBJECTIVE
This study aimed to develop an automated detection schema for otosclerosis with interpretable deep learning using temporal bone computed tomography images.
METHODS
With approval from the institutional review board, we retrospectively analyzed high-resolution computed tomography scans of the temporal bone of 182 participants with otosclerosis (67 male subjects and 115 female subjects; average age, 36.42 years) and 157 participants without otosclerosis (52 male subjects and 102 female subjects; average age, 30.61 years) using deep learning. Transfer learning with the pretrained VGG19, Mask RCNN, and EfficientNet models was used. In addition, 3 clinical experts compared the system's performance by reading the same computed tomography images for a subset of 35 unseen subjects. An area under the receiver operating characteristic curve and a saliency map were used to further evaluate the diagnostic performance.
RESULTS
In prospective unseen test data, the diagnostic performance of the automatically interpretable otosclerosis detection system at the optimal threshold was 0.97 and 0.98 for sensitivity and specificity, respectively. In comparison with the clinical acumen of otolaryngologists at P < 0.05, the proposed system was not significantly different. Moreover, the area under the receiver operating characteristic curve for the proposed system was 0.99, indicating satisfactory diagnostic accuracy.
CONCLUSION
Our research develops and evaluates a deep learning system that detects otosclerosis at a level comparable with clinical otolaryngologists. Our system is an effective schema for the differential diagnosis of otosclerosis in computed tomography examinations.
PubMed: 38655358
DOI: 10.1016/j.heliyon.2024.e29670