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Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2024To compare the application of endoscope and microscope in all kinds of stapes surgeries. Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in...
To compare the application of endoscope and microscope in all kinds of stapes surgeries. Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School. Hearing level, hospital stay post-operation, times of hospital visit post-operation, etc. have been compared between the endoscopic group and microscopic group. Patients who were failed to place the stapes prosthesis because of the poor exposure of the oval window have been analyzed. Otosclerosis was the most common diagnosis in both groups. There was 1(1/23) middle ear malformation in the endoscopic group and 5(5/36) middle ear malformations in the microscopic group. There were 2 Van Der Hover syndromes and 4 Treacher Collins syndromes in the microscopic group. In the endoscopic group ABG of 10 ears(43.5%) ≤ 10 dB, and ABG of 21 ears(91.3%) ≤20 dB.In the microscopic group ABG of 13 ears(41.9%) ≤ 10 dB, and ABG of 28 ears(90.3%) ≤ 20 dB. There was no statistic difference between 2 groups. Times of hospital visit post-operation in the endoscopic group was less than in the microscopic group(<0.01). There was no facial palsy, tympanic perforation or profound sensorineural hearing loss in both groups. Endoscope is more suitable for patients who are evaluated with no severe stapes malformation, or less manipulation of drilling the bone. It could also reduce the hospital visit post-operation. Patients with narrow ear canal or severe middle ear malformation are recommended to perform the surgery with microscope, because it provides the chance of manipulation with 2-hands of surgeons.
Topics: Humans; Stapes Surgery; Stapes; Ear, Middle; Otosclerosis; Endoscopes; Polyesters; Retrospective Studies; Treatment Outcome
PubMed: 38297862
DOI: 10.13201/j.issn.2096-7993.2024.02.005 -
Acta Oto-laryngologica Jan 2024Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration.
BACKGROUND
Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration.
AIM
The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery.
MATERIAL AND METHODS
Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear.
RESULTS
Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery.
CONCLUSION
Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.
SIGNIFICANCE
If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.
Topics: Humans; Otosclerosis; Audiometry, Pure-Tone; Stapes Surgery; Bone Conduction; Ear, Middle; Retrospective Studies; Adrenal Cortex Hormones; Dexamethasone; Treatment Outcome
PubMed: 38279924
DOI: 10.1080/00016489.2024.2304062 -
European Archives of... Jun 2024To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications.
PURPOSE
To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications.
METHODS
A retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2 and 3 kHz.
RESULTS
In total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air-bone gap (median = 7.5 and 9.4 dB, respectively), gain in air-bone gap (median = 20.0 and 18.1 dB, respectively), air-bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group.
CONCLUSION
The use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it.
Topics: Humans; Stapes Surgery; Retrospective Studies; Male; Otosclerosis; Female; Middle Aged; Adult; Audiometry, Pure-Tone; Postoperative Complications; Bone Conduction; Treatment Outcome; Ossicular Prosthesis; Aged; Prosthesis Design; Reoperation; Audiometry, Speech
PubMed: 38273045
DOI: 10.1007/s00405-023-08407-w -
European Archives of... Jul 2024To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser. (Observational Study)
Observational Study Comparative Study
PURPOSE
To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser.
METHODS
Retrospective observational study, which included patients treated with primary stapes surgery performed between January 2009 and January 2020. Three audiometric measurements (PTA, GAP and SDS) were evaluated as main results, evaluated by analysis of covariance (controlling the preoperative value). Intraoperative and postoperative complications were also analyzed. Outcomes were measured 6 months (± 1 month) after surgery.
RESULTS
153 cases were included, 97 operated with conventional technique and 56 with laser technique. Postoperative GAP ≤ 10 dB was obtained in 85.6% of the total sample, 82.5% in the conventional technique and 91.1% in the laser technique. Analysis of covariance showed no significant differences in the three surgery outcomes between the two groups (PTA, p = 0.277; GAP, p = 0.509 and SDS, p = 0.530). Regarding surgical complications, sensorineural damage was higher in the conventional technique group (p = 0.05). On the other hand, there were four cases of facial paresis, all in the laser group, three of them with the 980 nm laser.
CONCLUSIONS
Stapedotomy offered a high percentage of hearing success in the two groups studied. There were no significant differences in audiometric result, but there was a differential presentation of complications, being more frequent sensorineural hearing loss in the conventional technique group and facial paresis in the laser group.
Topics: Humans; Stapes Surgery; Female; Retrospective Studies; Male; Middle Aged; Lasers, Semiconductor; Adult; Otosclerosis; Postoperative Complications; Treatment Outcome; Aged; Laser Therapy; Audiometry
PubMed: 38219247
DOI: 10.1007/s00405-023-08429-4 -
The Annals of Otology, Rhinology, and... Apr 2024To investigate the role and distribution of various molecular markers using immunohistochemistry and immunofluorescence to further elucidate and understand the...
OBJECTIVE
To investigate the role and distribution of various molecular markers using immunohistochemistry and immunofluorescence to further elucidate and understand the pathogenesis of otosclerosis.
METHODS
Archival celloidin formalin-fixed 20-micron thick histologic sections from 7 patients diagnosed with otosclerosis were studied and compared to controls. Sections in the mid-modiolar region were immunoreacted with rabbit polyclonal antibodies against nidogen-1, β2-laminin, collagen-IX, BSP, and monoclonal antibodies against TGF β-1 and ubiquitin. Digital images were acquired using a high-resolution light and laser confocal microscope.
RESULTS
Nidogen-1, BSP, and collagen-IX were expressed in the otospongiotic regions, and to lesser extent, in the otosclerotic regions, the latter previously believed to be inactive. β2-laminin and ubiquitin were uniformly expressed in both otospongiotic and otosclerotic regions. There was a basal level of expression of all of these markers in the normal hearing and sensorineural hearing loss specimens utilized as control. TGF β -1, however, though present in the otosclerosis bones, was absent in the normal hearing and sensorineural hearing loss controls.
CONCLUSIONS
Our results propose that the activity and function of TGF-1 may play a key role in the development and pathogenesis of otosclerosis. Further studies utilizing a higher number of temporal bone specimens will be helpful for future analysis and to help decipher its role as a potential target in therapeutic interventions.
Topics: Humans; Rabbits; Animals; Otosclerosis; Cochlea; Hearing Loss, Sensorineural; Collagen; Laminin; Ubiquitins
PubMed: 38197255
DOI: 10.1177/00034894231225134 -
European Archives of... Jun 2024Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical... (Comparative Study)
Comparative Study
PURPOSE
Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique.
METHODS
This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test.
RESULTS
Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39 min versus 45 min for the microscopic technique.
CONCLUSIONS
The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.
Topics: Humans; Stapes Surgery; Retrospective Studies; Female; Male; Otosclerosis; Endoscopy; Tertiary Care Centers; Middle Aged; Adult; Microsurgery; Treatment Outcome; Aged; Operative Time
PubMed: 38158420
DOI: 10.1007/s00405-023-08411-0 -
The Laryngoscope May 2024To determine the outcomes and complications of endoscopic versus microscopic stapes surgery in patients with otosclerosis. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine the outcomes and complications of endoscopic versus microscopic stapes surgery in patients with otosclerosis.
STUDY DESIGN
Randomized, single-blinded clinical trial.
METHODS
Patients with otosclerosis who underwent either trans-canal microscopic or endoscopic stapedotomy at a tertiary care hospital were compared. Thirty-two patients were randomly divided into two groups using blocked randomization. Group A consisted of 16 patients who underwent trans-canal microscopic stapedotomy, and group B consisted of 16 patients who underwent trans-canal endoscopic stapedotomy. Postoperative vertigo, ear pain, and complications such as tympanic membrane perforation or chorda tympani nerve injury were evaluated. Three months postoperatively, patients were assessed for dysgeusia and hearing improvement.
RESULTS
The mean pre-operative air-bone gap (ABG) in the microscopic and endoscopic groups was 32.81 ± 6.82 and 30.00 ± 7.96, respectively. The mean improvement in the ABG was 25.45 ± 11.21 dB in the microscopic group and 23.21 ± 10.68 dB in the endoscopic group. Although both techniques showed improvement in auditory outcomes (p-value <0.001), there were no statistical differences between the endoscopic and microscopic groups in the pre-operative, post-operative, and mean improvement of ABG (p-value >0.05). There were no significant differences between the two methods in chorda tympanic nerve injury, vertigo scores, and the mean operating time (p-value >0.05), but the mean pain score was higher in the microscopic group (2.56 ± 1.55 in the microscopic group versus 1.31 ± 0.70 in the endoscopic group) (p-value = 0.003).
CONCLUSIONS
Endoscopic stapes surgery can be a preferable alternative to conventional microscopic stapedotomy, as it yields similar hearing outcomes and lower pain scores.
LEVEL OF EVIDENCE
2 Laryngoscope, 134:2395-2400, 2024.
Topics: Humans; Otosclerosis; Stapes Surgery; Endoscopy; Earache; Vertigo; Treatment Outcome; Retrospective Studies
PubMed: 38112392
DOI: 10.1002/lary.31241 -
The Journal of International Advanced... Nov 2023Variations along the facial nerve (FN) course present considerable challenges in the surgical treatment of otosclerosis, often complicating the procedure. Existing...
BACKGROUND
Variations along the facial nerve (FN) course present considerable challenges in the surgical treatment of otosclerosis, often complicating the procedure. Existing knowledge of its tympanic tract and its implications primarily comes from microscopical procedures. This study aims to assess endoscopic findings of FN anatomy in a healthy tympanic cavity and its impact on the stapedotomy procedure, focusing on the risk of complications and functional hearing outcomes.
METHODS
A retrospective study on exclusive endoscopic stapedotoplasties between October 2014 and October 2021 at our Otorhinolaryngology University Department was carried out. An evaluation of intraoperative endoscopic findings reviewed in surgical descriptive and/or video records was conducted to assess their potential negative impact on the surgery. Demographic data, preoperative and postoperative hearing thresholds, as well as intraoperative and postoperative complications were analyzed.
RESULTS
One hundred fifty-seven subjects were included. A FN partially overhanging the oval window was observed in 7.3% (n=12): 10 prolapsing with bony canal dehiscence and 2 without any detected dehiscence. Each procedure was successfully completed without any issues related to the anomalous anatomy, and in no case, switching to the microscope for the handling of the prosthesis near the dehiscent nerve was required. No facial paralysis occurred, with an early- or long-term postoperative House-Brackman grade of 1 (n=157, 100%). Only 3/157 patients (1.9%) showed a sensorineural threshold reduction of ≥20 dB HL, but a significant air-bone gap improvement was observed (mean closure of 18.36 dB HL, P -lt; .0001).
CONCLUSION
The endoscope promotes a concrete description of tympanic FN anatomy, and endoscopic stapes surgery appears to be a safe and viable option when dehiscent or prolapsed FNs reduce the footplate's exposure.
Topics: Humans; Facial Nerve; Retrospective Studies; Treatment Outcome; Stapes Surgery; Stapes; Otosclerosis
PubMed: 38088324
DOI: 10.5152/iao.2023.231195 -
The International Tinnitus Journal Dec 2023The purpose of this paper is to show how temporal bone histopathology has been instrumental in adding knowledge about the origin of tinnitus in the cochlea and how it...
The purpose of this paper is to show how temporal bone histopathology has been instrumental in adding knowledge about the origin of tinnitus in the cochlea and how it will still be useful for that purpose in the future. The papers published on this subject will be reviewed, and their contributions will be highlighted. The knowledge that is now part of the subject will be pointed out, and future research on this area will be pointed out.
Topics: Humans; Tinnitus; Endolymphatic Hydrops; Cochlea
PubMed: 38050885
DOI: 10.5935/0946-5448.20230009