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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 -
European Archives of... Dec 2022To compare the efficacy and safety characteristics of different materials used for oval window sealing during stapedotomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the efficacy and safety characteristics of different materials used for oval window sealing during stapedotomy.
METHODS
A systematic review was conducted according to the PRISMA guidelines. Published international English literature from January 1, 2000 to December 2021 was screened, checking for studies that compared different materials utilization in patients undergoing stapedotomy surgery for otosclerosis or congenital stapes fixation. Data related to the efficacy and safety of each material were extracted. The primary outcome measure was the air-bone gap (ABG) closure after surgical intervention.
RESULTS
Six studies were included in the metanalysis. Because of the heterogeneity of the treatments adopted, we assessed the use of the fat compared to all other treatments, and the use of the gelfoam compared to all other treatments. In the former analysis (fat vs others) we did not identify differences in ABG closure between the groups (p = 0.74), with a low heterogeneity of the results (I = 28.36%; Hedge's g = 0.04, 95% CI - 0.19 0.27); similarly, we did not identify differences between the use of gelfoam and other treatments (p = 0.97), with a low heterogeneity of the results (I = 28.91%; Hedge's g = 0.00, 95% CI - 0.20 0.21).
CONCLUSIONS
Numerous options are available for oval window sealing during stapedotomy, with acceptable safety and effectiveness profiles. Based on the current data, no definitive recommendation can be made regarding the choice of one material over another, and the convenience of sealing over no sealing at all.
Topics: Humans; Stapes Surgery; Otosclerosis; Gelatin Sponge, Absorbable; Ear, Middle; Postoperative Complications; Retrospective Studies; Treatment Outcome; Stapes
PubMed: 35857099
DOI: 10.1007/s00405-022-07551-z -
European Archives of... Jul 2018To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler.
OBJECTIVE
To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler.
STUDY DESIGN
Retrospective case review.
SETTING
Tertiary referral center.
PATIENTS AND INTERVENTIONS
This study concerns a retrospective analysis of the results of malleostapedotomy with the use of a self-fixing articulated titanium piston in 16 ears of 16 consecutively treated patients between 2005 and 2009. The medical files were used for the acquisition of data on medical and surgical history and to obtain pre- and postoperative audiometry. Diagnosis and outcomes of mainly revision surgeries are presented and compared to the literature.
MAIN OUTCOME MEASURES
Effect of (revision) malleostapedotomy by evaluating postoperative audiometry and air-bone gap closure.
RESULTS
The postoperative air-bone gap closure was ≤ 10 dB in 9/16 (56%) ears and within ≤ 20 dB in 13/16 (81%) ears. The mean postoperative air-bone gap was 14.3 dB HL (0.5-2.0 kHz) and 17.3 dB HL (0.5-4.0 kHz). Postoperatively, there was no increase in bone conduction thresholds larger than 3 dB (0.5-2.0 kHz) and postoperative dizziness was absent or very limited and transient.
CONCLUSIONS
The malleostapedotomy procedure has become surgically less demanding over time by the technical improvements present in the nowadays available pistons. The design of the self-fixing and articulated titanium piston used in the present group of patients allows a safe and straight-forward malleostapedotomy procedure. Present hearing outcomes match with results presented in the literature.
Topics: Adult; Aged; Audiometry; Bone Conduction; Female; Hearing Loss; Humans; Male; Malleus; Middle Aged; Otosclerosis; Postural Balance; Prostheses and Implants; Prosthesis Design; Reoperation; Retrospective Studies; Stapes Surgery; Titanium
PubMed: 29779038
DOI: 10.1007/s00405-018-4999-z -
Medical Science Monitor : International... Jun 2023BACKGROUND Otosclerosis is a pathology that interferes with the conduction of vibrations to the inner ear, triggering changes in the auditory ossicles and their...
BACKGROUND Otosclerosis is a pathology that interferes with the conduction of vibrations to the inner ear, triggering changes in the auditory ossicles and their associated joints due to mechanical overload. This study primarily aims to evaluate these overload-induced modifications in the stapes head resulting from the immobilization of the base of the third auditory ossicle in otosclerosis patients. MATERIAL AND METHODS We conducted a comparative analysis of patients undergoing their first surgery for otosclerosis. The test group consisted of 31 patients who underwent stapedotomy between 2020-2021. For comparison, we utilized a control group comprising stapes samples extracted during vestibular schwannoma surgeries via a transcochlear approach. A prospective analysis of bone tissue surface topography and chemical composition was executed using scanning electron microscopy (SEM). RESULTS SEM analysis of the stapes head in otosclerosis patients relative to the control group displayed no significant differences in chemical composition or the presence of otosclerotic foci. Nonetheless, various forms of bone tissue surface damage were noted on the stapes head in all otosclerosis patients. Mild changes were evident in 90% of the samples, while small linear bone tissue fractures were observed in 58% of the samples. Furthermore, minor osteophytic changes were detected in 16% of the samples. CONCLUSIONS The immobilization of the stapes base by otosclerotic foci instigates overloads in the incus-stapes joint, leading to the eventual remodeling of the stapes head articular surface.
Topics: Humans; Stapes; Otosclerosis; Microscopy, Electron, Scanning; Ear Ossicles; Stapes Surgery; Bone and Bones
PubMed: 37337421
DOI: 10.12659/MSM.939679 -
Ear, Nose, & Throat Journal Jun 2021Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery,...
OBJECTIVES
Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery, otorrhea, or tympanic membrane perforation. They are diagnosed by a pearl-like lesion on otoscopy and computed tomography (CT) scan showing an expansile soft-tissue mass. We describe a series of patients with no prior otologic history presenting with progressive unilateral conductive hearing loss and normal otoscopy. The CT scans showed ossicular erosion without obvious soft-tissue mass. Surgery confirmed incudostapedial erosion found to be cholesteatoma. In this study, we characterize the clinical course of patients diagnosed with isolated incudostapedial cholesteatoma (IIC) and review possible pathologic mechanisms.
METHODS
Retrospective review of IIC cases treated by the Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, 2014 to 2020. Data included patient demographics, clinical features, imaging, surgical findings, and audiologic data.
RESULTS
Five patients were diagnosed with IIC (3 [60%] female; mean age at presentation 10.7 years [range 5.5-16.0]). All patients presented with postlingual unilateral conductive hearing loss and normal otoscopy without any past otologic history; delay in diagnosis ranged from 4 months to several years. The CT scans showed ossicular chain erosion with an absent long process of the incus and/or stapes superstructure. All patients underwent middle ear exploration, revealing a thin layer of cholesteatoma in the incudostapedial region, confirmed by histopathology. Mean preoperative speech reception threshold was 55 dB and improved to a mean of 31 dB in the 4 patients who underwent ossicular chain reconstruction.
CONCLUSION
Isolated incudostapedial cholesteatoma should be included as a possible etiology in pediatric patients with insidious onset of unilateral conductive hearing loss with normal otoscopy, unremarkable otologic history, and a CT scan showing ossicular abnormality/disruption without notable middle ear mass. These patients should be counseled preoperatively regarding the possibility of cholesteatoma and should undergo middle ear exploration with possible ossiculoplasty.
Topics: Adolescent; Child; Child, Preschool; Cholesteatoma, Middle Ear; Ear Ossicles; Female; Hearing Loss, Conductive; Hearing Loss, Unilateral; Humans; Incus; Male; Ossicular Replacement; Retrospective Studies; Stapes
PubMed: 33237827
DOI: 10.1177/0145561320973785 -
European Annals of Otorhinolaryngology,... Jan 2022The main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The... (Observational Study)
Observational Study
OBJECTIVES
The main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The secondary aim was to compare the auditory involvement of the stapes between the two groups.
MATERIAL AND METHODS
A single-center observational study included adult patients operated on by ossiculoplasty for acquired cholesteatoma between 2015 and 2019. Endpoints comprised improvement in pure-tone average air-bone gap (PTA-ABG) and air-bone gap (ABG) at conversational frequencies and, independently, per frequency. 136 patients were included: 95 with conserved malleus (M+) and 41 with malleus removal (M(). Mean time to audiometric follow-up was 9 months in both groups.
RESULTS
The PTA-ABG improvement was 4.4±12.6dB for the M+ group and 3.8±13.4dB for the M- group, with no significant significance (P=0.8). Better results (not exceeding 7.5dB) were found for the M+ group at 2 and 8kHz (P=0.3 and P=0.052 respectively). Presence or absence of the stapes did not affect the results in either group.
CONCLUSION
Those results suggest a negligible role of the malleus in early hearing outcome of tympanoplasty for cholesteatoma. A slight improvement was observed in the M+ group at 2 and 8kHz, but its interpretation remains uncertain.
Topics: Adult; Audiometry, Pure-Tone; Cholesteatoma, Middle Ear; Cohort Studies; Hearing; Humans; Malleus; Ossicular Prosthesis; Ossicular Replacement; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34052161
DOI: 10.1016/j.anorl.2021.05.002 -
Hearing Research Jun 2021The human tympanic membrane (TM) and ossicles are generally considered to act as a linear system as they conduct low and moderate level environmental sounds to the...
The human tympanic membrane (TM) and ossicles are generally considered to act as a linear system as they conduct low and moderate level environmental sounds to the cochlea. At intense stimulus levels (> 120 dB SPL) there is evidence that the TM and ossicles no longer act linearly. The anatomical structures that contribute to the nonlinear responses and their level and frequency dependences are not well defined. We used cadaveric human ears to characterize middle-ear responses to continuous tones between 200 and 20,000 Hz with levels between 60 and 150 dB SPL. The responses of the TM and ossicles are essentially sinusoidal, even at the highest stimulus level, but grow nonlinearly with increased stimulus level. The umbo and the stapes show different nonlinear behaviors: The umbo displacement grows faster than the stimulus level (expansive growth) at frequencies below 2000 Hz, while the stapes exhibits mostly compressive growth (grows slower than the stimulus level) over a wide frequency range. The sound pressure level where the nonlinearity first becomes obvious and the displacement at that level are lower at the stapes than at the umbo. These observations suggest the presence of multiple nonlinear processes within the middle ear. The existence of an expansive growth of umbo displacement that has limited effect on the stapes compressive growth suggests that the ossicular joints reduce the coupling between multiple nonlinear mechanisms within the middle ear. This study provides new data to test and refine middle-ear nonlinear models.
Topics: Ear, Middle; Humans; Ossicular Prosthesis; Sound; Stapes; Tympanic Membrane; Vibration
PubMed: 33872835
DOI: 10.1016/j.heares.2021.108242 -
Bone Aug 2019Bone remodeling of the auditory ossicles and the otic capsule is highly restricted and tightly controlled by the osteoprotegerin (OPG)/receptor activator of nuclear...
Bone remodeling of the auditory ossicles and the otic capsule is highly restricted and tightly controlled by the osteoprotegerin (OPG)/receptor activator of nuclear factor kappa-Β ligand (RANKL)/receptor activator of nuclear factor kappa-Β (RANK) system. In these bony structures, a pathological decrease in OPG expression stimulates osteoclast differentiation and excessive resorption followed by accrual of sclerotic bone, ultimately resulting in the development of otosclerosis, a leading cause of deafness in adults. Understanding the signaling pathways involved in maintaining OPG expression in the ear would shed light on the pathophysiology of otosclerosis and other ear bone-related diseases. We and others previously demonstrated that Ca signaling through the L-type Ca1.2 Ca channel positively regulates OPG expression and secretion in long bone osteoblasts and their precursor cells in vitro and in vivo. Whether Ca1.2 regulates OPG expression in ear bones has not been investigated. We drove expression of a gain-of-function Ca1.2 mutant channel (Ca1.2) using Col2a1-Cre, which we found to target osteochondral/osteoblast progenitors in the auditory ossicles and the otic capsule. Col2a1-Cre;Ca1.2 mice displayed osteopetrosis of these bones shown by μCT 3D reconstruction, histological analysis, and lack of bone sculpting, findings similar to phenotypes seen in mice with an osteoclast defect. Consistent with those observations, we found that Col2a1-Cre;Ca1.2 mutant mice showed reduced osteoclasts in the otic capsule, upregulated mRNA expression of Opg and Opg/Rankl ratio, and increased mRNA expression of osteoblast differentiation marker genes in the otic capsule, suggesting both an anti-catabolic and anabolic effect of Ca1.2 mutant channel contributed to the observed morphological changes of the ear bones. Further, we found that Col2a1-Cre;Ca1.2 mice experienced hearing loss and displayed defects of body balance in behavior tests, confirming that the Ca1.2-dependent Ca influx affects bone structure in the ear and consequent hearing and vestibular functions. Together, these data support our hypothesis that Ca influx through Ca1.2 promotes OPG expression from osteoblasts, thereby affecting bone modeling/remodeling in the auditory ossicles and the otic capsule. These data provide insight into potential pathological mechanisms underlying perturbed OPG expression and otosclerosis.
Topics: Animals; Bone Diseases; Bone and Bones; Calcium Channels, L-Type; Calcium Signaling; Ear Ossicles; Ear, Inner; Ear, Middle; Female; Male; Mice; Osteoprotegerin
PubMed: 31121355
DOI: 10.1016/j.bone.2019.05.024 -
Acta Otorhinolaryngologica Italica :... Oct 2012The aim of the study was to describe ossicle resorption in chronic otitis with cholesteatoma and correlate it with clinical parameters such as age, contralateral ear...
The aim of the study was to describe ossicle resorption in chronic otitis with cholesteatoma and correlate it with clinical parameters such as age, contralateral ear condition, tympanic membrane aspect, cholesteatoma pathogenesis and extension, associated lesions and hearing threshold. Preoperative clinical data were collected for 140 patients with chronic otitis with cholesteatoma, whose ossicles were evaluated during surgery. 82% of patients showed ossicle resorption, with incus damage in 78% of cases. Multiple involvement was found in 45% of cases and the incus-stapes association was the most frequent. In 13 patients (11%) with ossicle damage, the ossicular chain was in continuity with a hearing threshold similar to patients without ossicular resorption. Ossicles were always damaged in congenital cholesteatoma and in case of associated lesions. Cholesteatoma extension was related to the incidence of ossicle resorption (p < 0.0001). Air and bone conduction worsened as the number of involved ossicles increased, while the air-bone gap remained stable. In conclusion, the origin and location of cholesteatoma are related to the site of ossicular damage, which is subsequent to the contact between bone and cholesteatoma. Pure-tone audiometry and air-bone gap do not reflect actual ossicular chain status. None of the other preoperative clinical parameters considered were reliable predictors of the condition of the ossicular chain.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholesteatoma, Middle Ear; Chronic Disease; Ear Diseases; Ear Ossicles; Female; Humans; Male; Middle Aged; Otitis Media; Young Adult
PubMed: 23326010
DOI: No ID Found -
Otology & Neurotology : Official... Sep 2021To better distinguish NOG-related-symphalangism spectrum disorder (NOG-SSD) from chromosomal 17q22 microdeletion syndromes and to inform surgical considerations in...
OBJECTIVES
To better distinguish NOG-related-symphalangism spectrum disorder (NOG-SSD) from chromosomal 17q22 microdeletion syndromes and to inform surgical considerations in stapes surgery for patients with NOG-SSD.
BACKGROUND
Mutations in NOG cause a variety of skeletal syndromes that often include conductive hearing loss. Several microdeletions of chromosome 17q22 lead to severe syndromes with clinical characteristics that overlap NOG-SSD. Isolated deletion of NOG has not been described, and therefore the contribution of NOG deletion in these syndromes is unknown.
METHODS
Two families with autosomal dominant NOG-SSD exhibited stapes ankylosis, facial dysmorphisms, and skeletal and joint anomalies. In each family, NOG was evaluated by genomic sequencing and candidate mutations confirmed as damaging by in vitro assays. Temporal bone histology of a patient with NOG-SSD was compared with temporal bones of 40 patients diagnosed with otosclerosis.
RESULTS
Family 1 harbors a 555 kb chromosomal deletion encompassing only NOG and ANKFN1. Family 2 harbors a missense mutation in NOG leading to absence of noggin protein. The incus-footplate distance of the temporal bone was significantly longer in a patient with NOG-SSD than in patients with otosclerosis.
CONCLUSION
The chromosomal microdeletion of family 1 led to a phenotype comparable to that due to a NOG point mutation and much milder than the phenotypes due to other chromosome 17q22 microdeletions. Severe clinical findings in other microdeletion cases are likely due to deletion of genes other than NOG. Based on temporal bone findings, we recommend that surgeons obtain longer stapes prostheses before stapes surgery in individuals with NOG-SSD stapes ankylosis.
Topics: Carpal Bones; Foot Deformities, Congenital; Genetic Heterogeneity; Hand Deformities, Congenital; Humans; Stapes; Synostosis; Tarsal Bones
PubMed: 34049328
DOI: 10.1097/MAO.0000000000003176