Results of Primary Malleostapedotomy in Stapes Fixation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the results of malleostapedotomy as primary surgical procedure in stapes fixation. SUBJECTS AND METHOD: This study was a retrospective chart review of 12 patients who underwent primary malleostapedotomy for conductive hearing loss. The intraoperative findings, surgical outcomes including audiologic data and complications were analyzed. RESULTS: Nine patients had ossicular fixation with ossicular anomalies and 3 patients had ossicular fixation alone. The median length of piston wire was 5.5 mm in total length. The preoperative mean bone and air-conduction thresholds were 57.5+/-8.8 (mean+/-SD) dB, 19.7+/-10.3 dB, respectively, and the mean air-bone gap (ABG) was 44.6+/-13.2 dB. After malleostapedotomy, hearings were improved and mean postoperative ABG was 11.1+/-11.3 dB. In eight patients (66.7%), ABG was reduced to 20 dB or less. There was no intraoperative or postoperative complication except for mild postoperative vertigo for 1 or 2 days. CONCLUSION: Malleostapedotomy can be a safe and effective surgical procedure as an alternative of incus stapedotomy in certain cases of absence or anomalous incus long process, and/or immobile incus in patients with stapes fixation.

CO2 Laser Stapedotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: CO2 laser is known to have optimal tissue characteristics for stapes surgery though it has suboptimal optical characteristics. Surgical experience of stapes surgery using CO2 laser has not been previously reported in Korea. In this study, authors assessed the functional outcomes of stapes surgery using CO2 laser and evaluated its merits and drawbacks. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 25 patients (28 ears) who underwent CO2 laser stapedotomy between November 2003 and December 2007. The patient's mean age was 42 years (range, 15-70), with the patients consisting of 11 males and 14 females. Follow-up duration ranged from 6 to 49 months and the mean observation time was 18.2+/-13.2 months. Hearing improvements at the final examination were evaluated by airbone gap closure. RESULTS: The pre-operative mean bone conduction threshold, air conduction thresholds and mean air-bone gap were 21.0+/-8.8 (mean+/-SD) dB, 51.3+/-7.2 dB and 30.1+/-7.8 dB, respectively. After stapedotomy, the mean bone conduction and air conduction thresholds were 20.5+/- 9.7 dB, 30.6+/-16.1 dB, respectively, and the mean air-bone gap was 10.1+/-7.1 dB at the last audiologic follow-up. The 'best results' were 18 cases (64.3%) and 'good results' were 8 cases (28.6%). The overall "succeccful" hearing improvement was achieved in 26 ears (92.9%). One case was classified as 'failure' and two cases developed post-operative benign paroxysmal positional vertigo. CONCLUSION: 92.9% of patients achieved satisfactory hearing results using CO2 laser stapedotomy. Although the manipulation of CO2 laser is difficult and limitation in gaining the anterior crus exposure maybe encountered due to suboptimal optical properties, these difficulties were not influential in gaining expertise of the instrument.

Hearing Results after Stapedotomy in Stapes Fixation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies have demonstrated that stapedotomy is a successful means of improving hearing for stapes fixation. The aim of this study was to analyze the pre and post-operative hearing improvements and causes of unsuccessful cases after stapedotomy. SUBJECTS AND METHOD: We reviewed the medical records and video recordings of 38 patients(39 ears) retrospectively who underwent stapedotomy between January 1994 and March 2006. Beside stapes fixation, patients, having other ossicular anomaly, stapes fixation in chronic middle ear disease and past history of ear surgery, were excluded. Patient ages ranged from 6 to 60 years, with the patients consisting of 15 males, 16 ears and 23 females, 23 ears. Observation ranged from 8 to 50 months and the mean observation time was 15.4+/-11.6 months. Hearing improvements at the final examination were designated as successful when air-bone gap was reduced to 20 dB or less. RESULTS: Pre-operative mean bone and air conduction thresholds were 21.6+/-10.8 (mean+/-SD) dBHL, 53.4+/-12.1 dBHL respectively and mean air-bone gap were 31.8+/-8.8 dB. After stapedotomy, mean bone and air conduction thresholds were 17.6+/-9.0 dBHL, 29.6+/-11.9 dBHL respectively and mean air-bone gap were 11.5+/-7.1dB at the last audiologic follow-up. Successful hearing improvements were achieved in 36 ears (92.3%). Three patients underwent revision surgery. CONCLUSION: This study suggests that stapes surgery is successful for hearing improvement for stapes fixation with unknown etiology.

Congenital Stapedial Fixation in Oto-Palato-Digital Syndrome: A Case Report / 대한이비인후과학회지

The Oto-palato-digital syndrome is a generalized skeletal dysplasia resulting in short stature, characteristic facies, and unusual deformities of the hands and feet. In addition, cleft palate and other congenital malformations are present. Some patients have conductive deafness due to dysplastic auditory ossicle which is sometimes stapes fixation. We experienced a case of Oto-palato-digital syndrome which showed bilateral stapes fixation, high-arched palate and syndactly of toes. Congenital stapes fixation was treated through partial stapedectomy with good hearing gain.

Clinical Applications of Multifrequency Tympanometry / 대한이비인후과학회지

BACKGROUND: Multifrequency tumpanograms for normal ears are expected to exhibit an orderly progression that were described by Vanhuyse. Middle ear pathologies alter tympanometric shapes at high frequencies and shift the resonance frequency of the middle ear transmission system. OBJECTIVE: The aims of this study were to obtain the normative data of the multifrequency tympanometry for adults and children, to evaluate the efficiency in diagnosing stapes fixation and to access the resonance properities of middle ears undergoing stapedotomy. MATERIAL AND METHODS: Multifrequency tympanometry was performed in 36 ears of normal adults, 24 ears of normal children and 8 ears with stapes fixation using computer-controlled acoustic immittance system(Virtual model 310). RESULTS: 1) In normal ears, as probe frequency increases, tympanometric patterns progressed through an orderly progression of shape, consistent with the Vanhuyse model. 2) Resonance frequeny was 1195+/-260 Hz for normal adults, and 1167+/-217 Hz for normal children. There was no significant different between two groups. 3) Resonance frequency was higher in cases of stapes fixation(1431+/-323 Hz) than the normal value and was lower in cases of post-stapedotomy(721+/-130 Hz) than the normal value. CONCLUSION: Measurement of multifrequency tympanometry could give additional information for the evaluation of ossicular fixation.