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Laryngoscope Investigative... Jun 2024This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS).
OBJECTIVES
This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS).
METHODS
A retrospective analysis was conducted on 36 consecutive ears in 33 patients who underwent stapes surgery using either EMS (EMS group) or EIS (EIS group). Operational practicability across surgical steps, postoperative hearing, operation time, switch of approach, and complications were compared between the two groups.
RESULTS
The EMS and EIS groups comprised seven (19.4%) and 29 ears (80.6%), respectively. The EMS group exhibited a greater proportion of moderate practicability in anchoring site exposure (42.9%, three of seven) and in securing the prosthesis (100%, seven of seven) in comparison to the EIS group, which had 0% (0 out of 29) and 41.4% (12 out of 29), respectively. Postoperative hearing improvements were equivalent between the groups, with EMS achieving a mean air-bone gap improvement of 28.8 dB and EIS of 23.2 dB. The ABG closure rates within 10 dB and 20 dB for the EMS group were 28.6% and 100%, respectively, and not significantly different from the EIS group ( = .103). However, the average surgical duration for EMS was extended by 77.4 min. The rate of complications was comparable between the groups (EMS 14.3%, EIS 10.3%, = 1.000).
CONCLUSION
The findings indicate that while EMS requires a longer operation time because of decreased practicability in specific surgical steps, it provides comparable outcomes to EIS, underscoring the potential of endoscopic techniques to establish malleostapedotomy as a surgical option as it is with traditional incudostapedotomy.
LEVEL OF EVIDENCE
4.
PubMed: 38803459
DOI: 10.1002/lio2.1273 -
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 Journal of Radiology Jun 2024To describe the reliability of ultra-high-resolution computed tomography (UHR-CT) in the measurement of titanium stapes prostheses using manufacturer data as a reference.
PURPOSE
To describe the reliability of ultra-high-resolution computed tomography (UHR-CT) in the measurement of titanium stapes prostheses using manufacturer data as a reference.
MATERIALS AND METHODS
This retrospective study included patients treated by stapedectomy with titanium prostheses who underwent UHR-CT between January 2020 and October 2023. Images were acquired using an ultra-high-resolution mode (slice thickness: 0.25 mm; matrix, 1024 × 1024). Two radiologists independently evaluated the length, diameter, and intra-vestibular protrusion of the prosthesis. Post-operative air-bone gaps (ABGs) were recorded.
RESULTS
Fourteen patients were enrolled (mean age, 44.3 ± 13.8 [SD] years, 9 females), resulting in 16 temporal bone UHR-CTs. The exact length was obtained in 81.3 % (n = 13/16) and underestimated by 0.1 to 0.3 mm in the remaining 18.7 % (n = 3/16) CT scans for both readers (mean misestimation: -0.02 ± 0.06 [SD] mm, overall underestimation of 0.43 %). The exact diameter was reported in 75 % (n = 12/16) and 87.5 % (n = 14/16) of the CT scans for readers 1 and 2, respectively, and was off by 0.1 mm in all discrepancies (mean misestimation: 0.01 ± 0.04 [SD] mm, overall overestimation of 2.43 %). Intravestibular prosthesis protrusion was of 0.5 ± 0.43 [SD] mm (range: 0-1) and 0.49 ± 0.44 [SD] mm (range: 0-1.1) for readers 1 and 2, respectively, and did not correlate with ABGs (r = 0.25 and 0.22; P = 0.39 and 0.47 for readers 1 and 2, respectively). Intra and interobserver agreements were excellent.
CONCLUSION
UHR-CT provides 99.6 % and 97.6 % accuracy for prosthesis length and diameter measurements, respectively.
Topics: Humans; Female; Male; Adult; Temporal Bone; Retrospective Studies; Tomography, X-Ray Computed; Reproducibility of Results; Ossicular Prosthesis; Stapes Surgery; Middle Aged; Titanium; Prosthesis Design
PubMed: 38636410
DOI: 10.1016/j.ejrad.2024.111467 -
PloS One 2024Elephants have a unique auditory system that is larger than any other terrestrial mammal. To quantify the impact of larger middle ear (ME) structures, we measured 3D...
Elephants have a unique auditory system that is larger than any other terrestrial mammal. To quantify the impact of larger middle ear (ME) structures, we measured 3D ossicular motion and ME sound transmission in cadaveric temporal bones from both African and Asian elephants in response to air-conducted (AC) tonal pressure stimuli presented in the ear canal (PEC). Results were compared to similar measurements in humans. Velocities of the umbo (VU) and stapes (VST) were measured using a 3D laser Doppler vibrometer in the 7-13,000 Hz frequency range, stapes velocity serving as a measure of energy entering the cochlea-a proxy for hearing sensitivity. Below the elephant ME resonance frequency of about 300 Hz, the magnitude of VU/PEC was an order of magnitude greater than in human, and the magnitude of VST/PEC was 5x greater. Phase of VST/PEC above ME resonance indicated that the group delay in elephant was approximately double that of human, which may be related to the unexpectedly high magnitudes at high frequencies. A boost in sound transmission across the incus long process and stapes near 9 kHz was also observed. We discuss factors that contribute to differences in sound transmission between these two large mammals.
Topics: Animals; Humans; Elephants; Ear, Middle; Sound; Stapes; Hearing; Vibration
PubMed: 38598472
DOI: 10.1371/journal.pone.0298535 -
Cureus Feb 2024A clinical condition known as chronic otitis media (COM) is characterized by tympanic membrane perforation, varying degrees of hearing loss, and otorrhea that lasts...
BACKGROUND
A clinical condition known as chronic otitis media (COM) is characterized by tympanic membrane perforation, varying degrees of hearing loss, and otorrhea that lasts for two to six weeks. COM alone or with cholesteatoma may result in ossicular chain discontinuity and ossicular erosion. The hearing restoration procedure includes repairing the eardrum and building the ossicular chain in ears with damaged ossicles. Multiple studies suggest the predictive value of preoperative air-bone gap (ABG) to detect the ossicular chain status can help with proper preoperative planning for surgery.
OBJECTIVE
To determine the degree of hearing improvement and reduction in ABG after tympanoplasty and to investigate the correlation between preoperative ABG and the status of the ossicular chain during surgery. Study design, setting, and date: This retrospective hospital file-based study was conducted at Aseer Central Hospital, Southern Region, Saudi Arabia, between November 2022 and April 2023. Hospital records of patients who underwent tympanoplasty during 2018-2023 were reviewed. Eighty-five patients were diagnosed with chronic suppurative otitis media (CSOM) between 2018 and 2023. A data collection sheet was employed to record extracted data, including the patient's age, sex, hearing assessment, type of surgical intervention, and outcome. We calculated the average of ABG decibels (dB) by summing the ABG values at 500 Hz, 1000 Hz, and 2000 Hz frequencies and dividing by three.
RESULTS
In the present study, data from 85 patients who underwent tympanoplasty were analyzed. Approximately one-third of the patients were in the age group of 31 to 40 years (25, 29.4%), and 50 (58.8%) of them were females. Chronic medical conditions were observed in 30 (35.3%) patients, with diabetes being reported in 19 (63.3%) of those cases. CSOM was found to be present in the left ear of 47 (56.0%) patients. Among the patients, 25 (29.4%) had subtotal perforations, 12 (14.1%) had marginal perforations, and two (2.4%) had total tympanic membrane perforations. The majority of patients (67, 78.8%) exhibited conductive hearing loss, while the remaining 18 (21.2%) had mixed hearing loss. Of the patients, 13 (15.3%) and 20 (23.5%) had fixed and disrupted ossicular chains, respectively. In terms of ossicular disruption, incudostapedial joint (ISJ) fixing (21.2%), fixed stapes (18.2%), and ISJ dislocation (18.2%) were the most prevalent kinds. Prior to operations, the mean ± SD of ABG was 22.6 ± 7.5. ABG values were 19.0 ± 9.3 on average after surgery. The statistical difference between pre- and postoperative ABG was statistically significant (paired t-test, p = 0.007), with a mean difference of -3.7. There were no significant differences between the different statuses of ossicular chains and the type of tympanic membrane perforation.
CONCLUSION
This study suggests that the degree of preoperative ABG (dB) is a valuable predictor of intraoperative ossicular chain status and can aid in preoperative planning for ossicular chain reconstruction. Furthermore, the study found that the type of tympanic membrane perforation preoperatively is not a reliable indicator of the ossicular chain status. Finally, tympanoplasty is considered a beneficial surgical procedure with a significant improvement in hearing status postoperatively.
PubMed: 38558666
DOI: 10.7759/cureus.55159 -
Scientific Reports Mar 2024One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic...
One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic inactivity. In contrast, it was recently demonstrated that titanium prostheses with an applied collagen matrix and immobilised growth factors stimulate osteoblastic activation and differentiation on the stapes footplate. Regarding those findings, the aim of this study was to evaluate the potential of bone regeneration including bone remodeling in the middle ear. Ten one-year-old female merino sheep underwent a middle ear surgery without implantation of middle ear prostheses or any other component for activating bone formation. Post-operatively, four fluorochromes (tetracycline, alizarin complexion, calcein green and xylenol orange) were administered by subcutaneous injection at different time points after surgery (1 day: tetracycline, 7 days: alizarin, 14 days: calcein, 28 days: xylenol). After 12 weeks, the temporal bones including the lateral skull base were extracted and histologically analyzed. Fluorescence microscopy analysis of the entire stapes with the oval niche, but in particular stapes footplate and the Crura stapedis revealed evidence of new bone formation. Calcein was detected in all and xylenol in 60% of the animals. In contrast, tetracycline and alizarin could only be verified in two animals. The authors were able to demonstrate the osseoregenerative potential of the middle ear, in particular of the stapes footplate, using fluorescence sequence labelling.
Topics: Sheep; Female; Animals; Fluorescent Dyes; Osteogenesis; Ear, Middle; Tetracyclines; Anthraquinones; Fluoresceins; Xylenes
PubMed: 38528064
DOI: 10.1038/s41598-024-57630-w -
Heliyon Mar 2024For experimental studies on sound transfer in the middle ear, it may be advantageous to perform the measurements without the inner ear. In this case, it is important to...
INTRODUCTION
For experimental studies on sound transfer in the middle ear, it may be advantageous to perform the measurements without the inner ear. In this case, it is important to know the influence of inner ear impedance on the middle ear transfer function (METF). Previous studies provide contradictory results in this regard. With the current study, we investigate the influence of inner ear impedance in more detail and find possible reasons for deviations in the previous studies.
METHODS
11 fresh frozen temporal bones were prepared in our study. The factors related to inner ear impedance, including round window membrane stiffness, cochleostomy, cochlea fluid and cochlea destruction were involved in the experimental design. After measuring in the intact specimen as a reference (step 1), the round window membrane was punctured (step 2), then completely removed (step 3). The cochleostomy was performed (step 4) before the cochlear fluid was carefully suctioned through scala tympani (step 5) and scala vestibuli (step 6). Finally, cochlea was destroyed by drilling (step 7). Translational and rotational movement of the stapes footplate were measured and calculated at each step. The results of the steps were compared to quantify the effect of inner ear impedance changing related to the process of cochlear drainage.
RESULTS
As the inner ear impedance decreases from step 1 to 7, the amplitudes of the METF curves at each frequency gradually increase in general. From step 6 on, the measured METF are significantly different with respect to the intact group at high frequencies above 3 kHz. The differences are frequency dependent. However, the significant decrement of rotational motion appears at the frequencies above 4.5 kHz from the step 5.
CONCLUSION
This study confirms the influence of inner ear impedance on METF only at higher frequencies (≥3 kHz). The rotational motions are more sensitive to the drainage of fluid at the higher frequency. Study results that found no influence of cochlea impedance may be due to incomplete drainage of the cochlea.
PubMed: 38524600
DOI: 10.1016/j.heliyon.2024.e27758 -
AIP Conference Proceedings Feb 2024When elicited by two stimulus tones (at frequencies and , > ), the amplitudes of specific distortion-product otoacoustic emission (DPOAE) components exhibit a...
When elicited by two stimulus tones (at frequencies and , > ), the amplitudes of specific distortion-product otoacoustic emission (DPOAE) components exhibit a characteristic bandpass shape as the ratio between and is varied. This bandpass shape has been attributed to various mechanisms including intracochlear resonance, suppression, and wave interference, and has been proposed to be related to cochlear frequency tuning. While human studies suggest modest correlations between psychophysical tuning and the tuning of DPOAE amplitude vs. / ratio functions, a relationship between the latter and the tuning of cochlear mechanical responses has yet to be established. This was addressed here through direct comparisons of DPOAEs and cochlear vibrations in wild-type CBA/CaJ mice. DPOAEs were elicited using a fixed-, swept- paradigm, and optical coherence tomography was used to measure displacements from cochlear locations with characteristic frequencies near . The tuning sharpness of 2- DPOAE ratio functions was found to be remarkably similar to that of basilar membrane and/or tectorial membrane responses to single tones, with the tuning sharpness of all responses increasing similarly with decreasing stimulus level. This relationship was observed for frequencies ranging from ~8 to 22 kHz. Intracochlear distortion products did not exhibit a bandpass shape as the / ratio was varied, indicating that interference between distortion products traveling to the stapes may be responsible for the tuning of the DPOAE ratio function. While these findings suggest that DPOAE ratio functions could be used to noninvasively infer cochlear tuning, it remains to be determined whether this relationship holds in other species and for lower frequency regions.
PubMed: 38516507
DOI: 10.1063/5.0195534 -
Journal of the Mechanical Behavior of... May 2024This study aims to introduce a novel non-invasive method for rapid material characterization of middle-ear structures, taking into consideration the invaluable insights...
This study aims to introduce a novel non-invasive method for rapid material characterization of middle-ear structures, taking into consideration the invaluable insights provided by the mechanical properties of ear tissues. Valuable insights into various ear pathologies can be gleaned from the mechanical properties of ear tissues, yet conventional techniques for assessing these properties often entail invasive procedures that preclude their use on living patients. In this study, in the first step, we developed machine-learning models of the middle ear to predict its responses with a significantly lower computational cost in comparison to finite-element models. Leveraging findings from prior research, we focused on the most influential model parameters: the Young's modulus and thickness of the tympanic membrane and the Young's modulus of the stapedial annular ligament. The eXtreme Gradient Boosting (XGBoost) method was implemented for creating the machine-learning models. Subsequently, we combined the created machine-learning models with Bayesian optimization (BoTorch) for fast and efficient estimation of the Young's moduli of the tympanic membrane and the stapedial annular ligament. We demonstrate that the resultant surrogate models can fairly represent the vibrational responses of the umbo, stapes footplate, and vibration patterns of the tympanic membrane at most frequencies. Also, our proposed material characterization approach successfully estimated the Young's moduli of the tympanic membrane and stapedial annular ligament (separately and simultaneously) with values of mean absolute percentage error of less than 7%. The remarkable accuracy achieved through the proposed material characterization method underscores its potential for eventual clinical applications of estimating mechanical properties of the middle-ear structures for diagnostic purposes.
Topics: Humans; Bayes Theorem; Ear, Middle; Tympanic Membrane; Vibration; Elastic Modulus; Finite Element Analysis
PubMed: 38493562
DOI: 10.1016/j.jmbbm.2024.106478