Comparison of Short-Term Hearing Outcome in Stapedotomy Using either Vein or Fat (Adipose Tissue) as Sealing Material

Abstract Introduction Otosclerosis is a common cause of conductive hearing loss in the adult population that is caused by fixation of the stapes footplate. Cochlear otosclerosis may also present with sensorineural or mixed hearing loss. Surgery is the definitive treatment of choice and, during the procedure, sealing of the oval window with autologous tissue graft around the stapes prosthesis has been routinely done to improve hearing outcome and to mitigate postoperative complications. Objectives To evaluate the efficacy of two different types of autologous tissue (vein or fat) grafts as oval window sealing materials in stapedotomy in improving short-term hearing outcomes. Methods In our study, 70 patients with otosclerosis who underwent primary stapedotomy were included. They were divided into group 1 (vein graft) and group 2 (fat graft) based on the type of sealing material used. All patients were followed-up at the end of 3 months, undergoing an audiometric examination to assess the hearing outcome. Results A total of 80% (n = 28) of the patients in group1 had an air-bone gap (ABG) closure < 10dB, and, in group 2, 85.7% had an ABG closure < 10 dB; this difference was found to be statistically insignificant. A total of 42.9% (n = 15) of the patients in group 1 and of 31.4% (n = 11) in group 2 had a significant improvement in bone conduction, while 14.3% (n = 5) of the patients in group 1 and 17.1% (n = 6) in group 2 had worsening of average bone conduction postoperatively, which was found to be statistically insignificant. Conclusions Both vein and fat grafts had comparable effects on hearing outcomes when used as sealing materials in stapedotomy.

Caracterización de pacientes con otosclerosis con estapedotomia a través de abordaje trascanal y retroauricular en un hospital universitario / Characterization of patients with otosclerosis with transcanal and retroauricular stapedotomy in a university hospital

Introducción: la otosclerosis manejada quirúrgicamente con estapedotomía ha mostrado mejora del umbral auditivo mediante un abordaje transcanal o retroauricular. Objetivo: caracterizar la respuesta al tratamiento quirúrgico con estapedotomía transcanal y retroauricular en pacientes con diagnóstico de otosclerosis en un centro universitario. Diseño: estudio observacional descriptivo retrospectivo tipo serie de casos. Metodología: se incluyeron pacientes con diagnósticos de otosclerosis atendidos en el Hospital Universitario Clínica San Rafael quienes cumplieron criterios de elegibilidad entre 2014 y 2020. Resultados: Se incluyeron 33 pacientes intervenidos con abordaje transcanal y 8 con abordaje retroauricular, la edad promedio fue de 46,6 años. La mayoría de pacientes fue de sexo femenino (56,1 %). Se evidenció una mejora del umbral auditivo en el 89,9 % del total de la muestra. La presencia de variantes anatómicas se describió en un 26,8 %, la variante más común fue el prolapso del nervio cuerda del tímpano (14,5 %). La complicación intraoperatoria más común fue la sección del nervio cuerda del tímpano (9,8 %). La presencia de complicaciones y variantes anatómicas fue más prevalente con abordaje retroauricular. Conclusiones: la estapedotomía con abordaje retroauricular y transcanal mostró mejoría del umbral auditivo equiparable a la literatura mundial, la presencia de variantes anatómicas se correlacionó con complicaciones posoperatorias.

Introduction: Otosclerosis managed surgically with stapedotomy has shown improvement in hearing threshold using a transcanal or retroauricular approach. Objective: To characterize the response to surgical treatment with transcanal and retroauricular stapedotomy in patients diagnosed with otosclerosis in a university center. Design: Retrospective descriptive observational study, case series type. Methodology: Patients with a diagnosis of otosclerosis treated at the Hospital Universitario Clínica San Rafael who met the eligibility criteria between 2014 and 2020 were included. Results: 33 patients operated with transcanal approach and 8 with retroauricular approach were included, the average age was 46.6 years. Most patients were female (56.1%). Hearing threshold improvement was evidenced in 89.9% of the total sample. The presence of anatomical variants was described in 26.8%, the most common variant was the prolapse of the chorda tympani nerve (14.5%). The most common intraoperative complication was eardrum cord nerve section (9.8%). The presence of complications and anatomic variants was more prevalent with retroauricular approach. Conclusion: Stapedotomy with retroauricular and transcanal approach showed improvement of hearing threshold comparable to the world literature, the presence of anatomical variants was correlated with postoperative complications.

Resultados auditivos del tratamiento quirúrgico de la otoesclerosis en el departamento de otorrinolaringología de la Pontificia Universidad Católica de Chile / Auditory results of surgical treatment of otosclerosis in the department of otolaryngology of the Pontificia Universidad Católica de Chile

RESUMEN Introducción: La otoesclerosis representa la causa de hipoacusia de conducción más común en adultos jóvenes. Las opciones de tratamiento incluyen amplificación mediante audífonos o resolución quirúrgica a través de cirugías como estapedectomía total o parcial, estapedostomía o implante coclear. Objetivo: Describir los resultados del tratamiento quirúrgico de la otoesclerosis en el Departamento de Otorrinolaringología del Hospital Clínico de la Pontificia Universidad Católica de Chile entre los años 1999 y 2018. Material y método: Se realizó un estudio de cohorte no concurrente con revisión de fichas clínicas y protocolos operatorios de pacientes atendidos en nuestro centro. Se registraron y analizaron las características biodemográficas de los pacientes, técnicas quirúrgicas, resultados auditivos, complicaciones, necesidad de reintervención y uso de audífono. Resultados: De un total de 78 pacientes sometidos a estapedectomía parcial (platinectomía parcial) o estapedostomía se incluyeron finalmente 37 quienes tenían datos clínicos completos, lo que corresponde al 47,4% del total. En ambos tipos de cirugía el promedio de gap óseo-aéreo varió de 30,8 dB en el preoperatorio a 13,9 dB en el posoperatorio lo cual es estadísticamente significativo. El promedio de variación de la vía aérea, éste fue mayor en el grupo de pacientes operados de estapedostomía, sin existir diferencias estadísticamente significativas al realizar test no paramétricos. Conclusión: Las características demográficas y los resultados auditivos obtenidos en nuestro centro son comparables con los descritos en la literatura. No existen diferencias significativas en cuanto al tipo de cirugía y la frecuencia y tipo de complicaciones, aunque se observan mejores resultados auditivos en los pacientes operados de estapedostomía.

ABSTRACT Introduction: Otosclerosis represents the most common cause of hearing loss in young adults. Treatment options include amplification with hearing aids or surgical resolution with surgeries such as total and partial stapedectomy, stapedostomy or cochlear implant. Aim: To describe the results of the surgical treatment of otosclerosis in the Otorhinolaryngology Department of the Clinical Hospital of the Pontificia Universidad Católica de Chile between the years 1999 and 2018 Material and method: A non-concurrent cohort study was performed with review of clinical files and operative protocols of patients seen in our center. The biodemographic characteristics of the patients, surgical techniques, auditory results, complications, need for reoperation and use of hearing aid were recorded and analyzed. Results: Of a total of 78 patients undergoing partial stapedectomy or stapedostomy, 37 were finally included, who had complete clinical data, which corresponds to 47.4% of the total. In both types of surgery, the average bone-air gap varied from 30.8 dB in the preoperative to 13.9 dB in the postoperative period, which is statistically significant. Regarding the average of variation of the airway, this was higher in the group of patients operated by stapedostomy without statistically significant differences when performing nonparametric tests. Conclusion: The demographic characteristics and the auditory results obtained in our center are comparable with those described in the literature. There are no significant differences in the type of surgery and the frequency and type of complications, although better hearing results are observed in patients operated by stapedostomy.

Medidas de imitância acústica de banda larga em indivíduos com otosclerose / Wideband acoustic immittance measurements in subjects with otosclerosis

Na prática clínica, nota-se uma dificuldade em identificar a rigidez do sistema tímpano-ossicular decorrente da Otosclerose por meio dos métodos de avaliação rotineiramente empregados. Assim, as medidas de imitância acústica de banda larga podem fornecer mais informações sobre a condição do sistema tímpano-ossicular por avaliarem uma ampla faixa de frequência. O objetivo do estudo foi caracterizar as medidas de imitância acústica de banda larga com os estímulos tom puro e chirp em indivíduos com diagnóstico de Otosclerose submetidos à estapedectomia ou estapedotomia. Foram avaliados 40 indivíduos na faixa etária de 33 a 80 anos, totalizando 54 orelhas operadas e 22 orelhas não operadas. A avaliação audiológica foi realizada por meio da otoscopia, audiometria tonal liminar, logoaudiometria e imitanciometria. As medidas de imitância acústica de banda larga foram obtidas por meio do sistema de medidas Middle-Ear Power Analyzer MEPA3, versão 5.0 (Mimosa Acoustics), utilizando os estímulos tom puro e chirp. Os dados obtidos foram submetidos à análise estatística descritiva e inferencial, com nível de significância de 0,05. As orelhas com Otosclerose apresentaram maior absorvância em 750 Hz, uma tênue diminuição até 3000 Hz, acentuando-se a partir desta frequência. A magnitude da admitância foi maior na faixa de frequência de 1992 a 4008 Hz, assim como a magnitude da impedância foi maior nas frequências baixas com diminuição até 4008 Hz e aumento em 6000 Hz. Estas orelhas foram dominadas pela rigidez nos sons graves e médios, por resistência entre 3000 e 4008 Hz e a partir desta frequência pela massa. A fase da impedância foi maior em 258 Hz e o delay da reflectância (slope) apresentou uma variação de comportamento entre as frequências, não sendo possível caracterizar um padrão de resposta. Conclui-se que há diferenças nas medidas obtidas nas orelhas com Otosclerose submetidas à cirurgia, quando analisadas as frequências baixas e médias, o que demonstra o impacto positivo da intervenção cirúrgica na funcionalidade do sistema tímpano-ossicular.(AU)

In clinical practice, there is a difficulty in identifying the rigidity of the tympano-ossicular system resulting from Otosclerosis through the routinely employed evaluation methods. Thus, wideband acoustic immitance measurements can provide more information on the condition of the tympanic-ossicle system by evaluating a wide frequency range. This study aimed at characterizing the wideband acoustic immitance measurements with the pure tone and chirp stimuli in individuals diagnosed with Otosclerosis submitted to stapedectomy or stapedotomy. Forty individuals aged 33 to 80 years were evaluated, totaling 54 operated and 22 non-operated ears. Audiology assessment was performed through otoscopy, pure-tone audiometry, logoaudiometry and imitanciometry. Wideband acoustic immitance measurements were obtained using the Middle-Ear Power Analyzer (MEPA3), version 5.0 (Mimosa Acoustics), by means of pure tone and chirp stimuli. Data were submitted to descriptive and inferential statistical analysis, with a significance level of 0.05. The ears with Otosclerosis presented a greater absorbance in 750 Hz, a slight diminution until 3000 Hz, being accentuated from this frequency. The admittance magnitude was higher in the frequency range from 1992 to 4008 Hz, as well as the impedance magnitude was higher in the low frequencies with a decrease up to 4008 Hz and an increase in 6000 Hz. These ears were dominated by rigidity in the low and medium sounds, by resistance between 3000 and 4008 Hz, and from this frequency, by the mass. The impedance phase was higher at 258 Hz and the reflectance delay (slope) showed a behavioral variation between the frequencies, a response not being characterized. It can be concluded that there are differences in the measurements obtained in Otosclerosis ears submitted to surgery, when the low and medium frequencies were analyzed, which demonstrates the positive impact of the surgical intervention on the tympano-ossicle system.(AU)

Surgical Findings and Results of Stapes Surgery for Stapedial Fixation in Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Stapes surgery has been reported to improve hearing for stapedial fixation. This study aimed to review the surgical findings and hearing results of stapes surgeries for 20 ears with stapedial fixation. SUBJECTS AND METHOD: We reviewed the medical records and video recordings of 20 consecutive stapes surgeries between 2011 and 2014. Patient age ranged from 20 to 64 years, representing 5 males and 12 females. Mean audiologic follow-up duration was 11 months. Hearing improvement at the final pure-tone audiometry was determined to be successful when air-bone gap (ABG) was reduced to 20 dB or less, and excellent when ABG was reduced to 10 dB or less. Surgery-related deterioration of bone-conduction (BC) was determined to be positive when the difference between final and preoperative BC was more than 15 dB, and over-closure positive when final air-conduction (AC) was better than preoperative BC. RESULTS: Pre-operative threshold frequency for BC and AC were 39.8+/-15.8 and 66.4+/-15.3 dB HL, respectively, and ABG was 26.6+/-10.2 dB. After the stapes surgery, the thresholds for BC and AC were 36.8+/-16.3 and 42.0+/-16.2 dB HL, respectively, and ABG was 5.2+/-6.5 dB during the last follow-up. After surgery, BC threshold was significantly improved at 2 kHz, whereas AC threshold improved at all frequencies. Excellent hearing improvement was accomplished in 16 ears (80%) and successful improvement in all ears (100%). Over-closure was observed in 7 ears (35%). There were no patients with surgery-related sensorineural hearing loss. CONCLUSION: Stapes surgery is effective for improving hearing for stapedial fixation. Operator should be able to cope with various situations during or after the stapes surgery.

Resultados auditivos y hallazgos quirúrgicos en pacientes con cirugía bilateral por otoesclerosis / Audiological outcome and surgical findings in patients with bilateral surgery for otosclerosis

Introducción: A pesar de las ventajas de la audición biaural, el manejo quirúrgico del segundo oído en pacientes con otoesclerosis bilateral fue por años un tema controversial debido a su riesgo potencial de hipoacusia sensorioneural. Objetivo: Describir los resultados audiológicos y quirúrgicos en pacientes operados bilateralmente por otoesclerosis en nuestro hospital entre 1988-2011. Material y método: Estudio retrospectivo de 56 pacientes en quienes se realizó cirugía de otoesclerosis en ambos oídos, mediante revisión de fichas clínicas. Resultados: En 13,5 por ciento de 415 pacientes se realizó cirugía bilateral. La edad promedio fue 44,2 +/- 7,7 (hombres) y 42,0 +/- 10,4 años (mujeres). La mejoría de los umbrales auditivos aéreos promedios en la primera y segunda cirugía fue de 33,6y 29,2 dB respectivamente, mientras que la de los umbrales óseos fue de 7,0y 3,0 dB correspondientemente. Las dificultades quirúrgicas para la primera y segunda cirugía fueron, respectivamente: platina flotante 0 por ciento y 2,5° por ciento, platina obliterada 5,4 por ciento y 5,1 por ciento, nicho profundo 5,4 por ciento y 0 por ciento, facial proscidente 38,5 por ciento y 43,2 por ciento, facial dehiscente 18,2 por ciento y 13,8 por ciento y sección de cuerda del tímpano 2 por ciento y 5,7 por ciento. Discusión: Los resultados auditivos del segundo oído son comparables a los de la primera cirugía. Esto, junto a la ausencia de complicaciones significativas, apoya la realización de intervenciones quirúrgicas bilaterales en otoesclerosis. Conclusión: La cirugía del segundo oído en hipoacusia bilateral por otoesclerosis es una alternativa segura y confiable.

Introduction: Despite the advantages of binaural hearing, surgical management of the second ear in patients with bilateral otosclerosis was for years a controversial topic due to the risk of sensorineural hearing loss. Aim: To describe the surgical and audiological results of patients with bilateral surgeries for otosclerosis in our hospital between 1988-2011. Material and method: Retrospective study based on clinical charts revision. Results: 13.5 percent of the 415 patients underwent bilateral surgery. The average age was 44.2 +/- 7.7 (men) and 42.0 +/- 10.4 years (women). There was a 33.6 dB improvement in average air-conduction hearing thresholds in the first surgery and 29.2 dB for the second, while the mean bone-conduction improved 7.0 and 3.0 dB for the first and second surgery correspondingly. The surgical difficulties found in the first and second surgeries were, respectively: floating platens 0 percent and 2.5 percent, obliterated platens 5.4 percent and 5.1 percent, deep niche 5.4 percent and 0 percent, facial overhang 38.5 percent and 43.2 percent, dehiscent facial 18.2 percent and 13.8 percent and chorda tympani section 2 percent and 5.7 percent. Discussion: Hearing results for the second ear were comparable to the first surgery. This, together with the absence of significant complications, supports a bilateral surgical approach. Conclusion: Surgery of the second ear in bilateral hypoacusia due to otosclerosis has proven to be a safe and reliable alternative.

Prótese ossicular em orelha média: o que procurar?: [revisão] / Prosthetic ossicular on middle ear: what look?: [review]

O objetivo deste trabalho foi demonstrar os achados tomográficos normais e patológicos encontrados no pós-operatório de pacientes submetidos a implantes de prótese ossicular, avaliados retrospectivamente por tomografia computadorizada. A estapedectomia com inserção de prótese é considerada o método ideal em indivíduos com fechamento da janela oval secundário a otosclerosefenestral ou causas inflamatórias. Vários tipos de prótese são utilizados, dependendo da extensãoda doença e preferência do cirurgião. Os autores, após revisão da literatura, descrevem os achadospós-operatórios considerados normais e as várias complicações inerentes ao procedimentocirúrgico, incluindo perfuração da membrana timpânica, processo inflamatório pós-operatório, necrosecom subluxação ou extrusão da prótese, desenvolvimento de granuloma/colesteatoma oufibrose periprotética, fístula perilinfática, lesão do nervo facial, dentre outras. Os achados tomográficos relacionados ao pós-operatório, bem como às complicações supracitadas, são de grande importância para o conhecimento dos radiologistas, sendo imprescindível para a propedêutica diagnóstica uma estreita correlação clínico-cirúrgica.

The aim of this essay was to demonstrate the normal and pathological CT findings of the post-operative imaging of patients underwent ossicular prosthesis implants. The stapedectomy replacedby prosthesis is considered the “gold standard” treatment of patients with oval window closure, related to otosclerosis or otherinflammatory conditions. Several types of prosthesis are availableand the choice depends on the extension of the disease or thesurgeon’s preferences. Based on extensive literature review, thenormal postoperative findings, as well as some surgery inherentcomplications were described, including among others: perforationof the tympanic membrane, necrosis associated with subluxation/extrusion of the prosthesis. granuloma/cholesteatoma or periprosthetic fibrosis, perilymphatic fistula, facial nerve damage. The knowledge of post-operative and related complications CT findings is extremely useful for head and neck radiologist, but it is essentialfor an assertive diagnoses a close clinical correlation.

Stapes fixation surgery: stapedectomy versus stapedotomy.

Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest.

Cirugía de la otoesclerosis: estapedectomía y estapedotomía / Surgery of otosclerosis: stapedectomy and stapedotomy

Objetivo: Caracterización de la experiencia quirúrgica reciente en el tratamiento de la otoesclerosis.Materiales y método: Revisión sistemática de la historia clínica de pacientes operados por el autordurante el período enero 2005 a diciembre 2009. Resultados: Desde enero de 2005 a diciembre de 2009 se realizaron 246 cirugías de estribo en 201pacientes con diagnóstico de otoesclerosis en la Clínica Rivas de Bogotá, Colombia. 230 fueronprocedimientos de primera intervención y 16 de revisión. Se realizaron 213 estapedotomías y 19 estapedectomías. Se reportan en 50 intervenciones (20,3%) complicación perioperatoria siendo en su mayor proporción las relacionadas con desgarro de la membrana timpánica o piel del conductoauditivo externo (CAE) (56%), luxación de la platina (26%) y otras causas 18%.Conclusiones: Se corrobora la tendencia de incidencia de otosclerosis en la población de mujeres y es aún mayor en los casos operados bilateralmente. La estapedotomía es el procedimiento de elección para la cirugía de la otosclerosis en nuestros pacientes. La estapedectomía total o parcial se realizasólo en casos excepcionales. Importancia clínica: Consideraciones sobre la técnica quirúrgica. Accesibilidad a base de datos internacional de otología.

Objective: To characterize the recent surgical experience to treat otosclerosis.Materials and methods: systematic review of the surgical record of patients that have been operated on by the author during the period of January, 2005 to December, 2009. Results: From January, 2005 to December, 2009; 246 stapes surgeries were performed in 201 patients who had been diagnosed with otosclerosis at Clínica Rivas from Bogotá, Colombia. 230 of these werefirst time interventions and 16 of them were revisions. 213 stapedotomies were performed and 19 stapedectomies. Perioperatory complications were reported in 50 of the surgeries (20.3%). Out of those 50 surgeries the ones with the highest proportion were the ones related to tears of the tympanicmembrane or of the skin of the external auditory canal (EAC), (56%), dislocation of the foot plate (26%) and other causes 18%. Conclusions: A tendency for the incidence of otosclerosis is corroborated in the women populationand is even higher in those cases that have been bilaterally operated on. Stapedotomy is the procedure of choice to surgically treat our patients suffering from otosclerosis. Total or partial stapedectomy is performed under in exceptional cases. Clinical interest: Considerations on the surgical technique. Accessibility to an International Databaseof Otology.

The Analysis of High Frequency Sensorineural Hearing Loss Caused by Piston Technique of Stapes Surgery in Patient with Otosclerosis / 听力学及言语疾病杂志

Objective To examine the causes of high frequency sensorineural hearing loss caused by piston technique of stapes surgery.Methods The retrospective analysis involved in thirty cases(49 ears)with stapedectomy from February 2004 to 2009 at our hospital.Pure tone audiometry was performed for each patient who underwent stapedectomy both during the two days preoperation and 1,3,6 months postoperation.Results One month after operation at 8000 Hz,the air conduction hearing threshold was 8 dB less than that before,4 000 Hz average bone conduction hearing threshold was 10 dB less than that before(P < 0.01).The average high-frequency hearingthreshold of ≥40 years old group was noticeably declined than that of 40 years old group(P < 0.01).There was no association between the tinnitus and high frequency hearing loss.(P >0.05).Conclusion Transient high-frequency sensorineural hearing losses occurred to most patients under going stapedectomy,but showed significant improvement,3 months after the surgery.The average high-frequency hearing threshold of ≥40 years old group was seriously declined than that of 40 years old group.

Resultados da cirurgia para otospongiose com dois tipos de prótese em procedimentos realizados por residentes / Results of stapes surgery for otosclerosis with two kinds of prothesis in residency training

A cirurgia do estapédio é um dos tratamentos indicados para a melhora da surdez condutiva secundária à otospongiose. O procedimento requer habilidade e experiência do cirurgião e faz parte do treinamento durante a residência médica. OBJETIVOS: Avaliar qual tipo de prótese (teflon ou mista de metal e aço) apresenta melhores os resultados auditivos em cirurgias realizadas por residentes e a incidência de complicações. MATERIAL E MÉTODOS: Foram avaliadas retrospectivamente 189 intervenções cirúrgicas que tiveram participação ativa de residentes, comparando-se os dois tipos de prótese utilizados. Os resultados audiométricos foram analisados conforme orientação do Committee on Hearing and Equilibrium e segundo o Amsterdam Hearing Evaluation Plots. RESULTADOS: O gap aéreo-ósseo diminuiu em média 21,90 dB (p<0,05) após o procedimento cirúrgico no grupo da prótese de teflon e 21,37 dB (p<0,05) no grupo da prótese mista, sendo o ganho do IRF de 22,33 e 26,10 dB (p<0,05), e o gap aéreo-ósseo foi inferior a 20 dB em 80,6 por cento e 85,04 por cento, respectivamente. CONCLUSÕES: Não evidenciamos diferenças no resultado audiométrico e na incidência de complicações quando comparamos o tipo de prótese utilizada. Acreditamos ser válida a execução desse procedimento em serviços de treinamento de médicos residentes, independente do tipo de prótese.

Stapes surgery is one of the approaches indicated to treat conductive hearing loss secondary to otosclerosis. The procedures requires skill and experience from the surgeon and is part of medical residency training. AIMS: To assess which type of prosthesis (Teflon or metal/steel) presents the best results in surgeries performed by residents and the incidence of complications. MATERIALS AND METHODS: we retrospectively assessed 189 interventions that counted on the active participation of resident physicians, and we compared the two types of prosthesis used. Audiometric results were analyzed following the guidelines from the Committee on Hearing and Equilibrium and also according to the Amsterdam Hearing Evaluation Plots. RESULTS: Bone-air gap reduced in an average value of 21.90 dB (p<0.05) after the surgery in the group that received the Teflon prosthesis and 21.37 dB (p<0.05) in the group that received the mixed prosthesis, and gain in SRI was of 22.33 and 26.10 dB (p<0.05), and the air-bone gap was below 20 dB in 80.6 percent and 85.04 percent, respectively. CONCLUSIONS: We did not see differences in the audiometry and in the incidence of complications when we compared the type of prosthesis used. We believe it is valid to continue teaching this procedure in medical residency training programs, regardless of the type of prosthesis.

Clinical Manifestations and Surgical Results of Malleostapedotomy and Malleostapedectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Incus stapedotomy is usually performed for the patients with otosclerosis and congenital ossicular fixation. However, for the patients whose incus is absent, anomalous or fixed, the piston wire cannot be placed around the incus. For these cases, malleostapedotomy or malleostapedectomy could be a proper treatment instead of incus stapedotomy. The aim of this study was to evaluate the clinical manifestation and treatment outcome of malleostapedotomy and malleostapedectomy. SUBJECTS AND METHOD: From January 1993 through March 2007, there were four malleostapedotomies and three malleostapedectomies. The medical records of these patients were retrospectively reviewed. The length of piston, ossicular condition, hearing improvement and postoperative complications were investigated. RESULTS: Conventional incus stapedotomy was not possible due to incus anomaly in three cases, incus fixation in two cases, incus removal during the previous surgery in one case and incus defect due to previous surgery in one case. The median length of prosthesis was 5.5 mm. The median preoperative air-bone gap was 42 dB and postoperative air-bone gap was 12 dB. The postoperative air-bone gap level was smaller than 10 dB in three patients, 11-20 dB in one patient, 21-30 dB in one patients, and 31-49 dB in one patient. Except for one case that had extrusion of the prosthesis after eight years, there was no intraoperative or postoperative complication. CONCLUSION: Malleostapedotomy or malleostapedectomy may be a good alternative surgical procedure to routine incus stapedotomy in cases of absence, anomaly or fixation of the incus.

Influence of Total Stapedectomy and Suction Noise on Cochlear Function and Ultrastructures in Guinea Pigs / 听力学及言语疾病杂志

In this study, the influence of the duration of opening vestibular window and the application of suction in auditory bulla on cochlear function and ultrastructures were observed by ECochG and scanning and transmission election microscopy in 44 guinea pigs divided into six groups. The results were as follows: (1) The CAP thresholds progressively enhanced as the prolongation of duration in some of outer hair cells in the basal turn occured 180 minutes after total stapedectomy. (2)Significant CAP threshold shift and irreversible pathological changes in some outer hair cells in the basal turn of cochlea were found with continuous suction for 60 minutes in auditory bulla after total stapedectomy. (3)CAP threshold shift without damage of outer hair cells could be fourd with the application of suction for 60 mimutes in auditory bulla before stapedectomy. The results suggested that opening vestibular window for longer time with suction in auditory bulla might be one of the factors to cause postoperative sensorineural hearing loss in total stapedectomy. But the suction noise might not be enough to cause postoperative sensorineural hearing loss in tympanoplasty due to its relatively low intensity.