Manual stapedotomy still holds good in the era of laser.

Context: In the present era of stapedotomy, there is an inevitable role for laser. But the conventional technique with manual burr still has its own merits in various settings such as usage in resource poor setting in developing countries and avoidance of laser hazards. AIMS: To evaluate the audiometric outcomes after manual stapedotomy. Settings and Design: The present study was retrospective record-based study. Patients who have been diagnosed otosclerosis and those who were not willing for surgery with laser, but gave consent for manual stapedotomy were included for the study. Materials and Methods: Preoperatively, and at each subsequent post-operative follow-up visits, patients were required to undergo a pure-tone audiogram. The air-bone gaps at the end of 6 months were used for final analysis. Statistical Analysis Used: Data was analyzed with using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Descriptive frequency distributions, mean, standard deviation of audiometric data were calculated. The paired t test was done to see the improvement in the air bone gap post-operatively. Results: The mean age of presentation is 32.2 years. Overall, the male:female ratio was found to be 1:1.2. Post-operative air bone closure to 15 decibels was obtained in 80% of patients. There was no significant correlation between the pre-operative hearing loss and post-operative gain, age, and gender of distribution of focus. Conclusions: The post-operative hearing after stapedotomy has been remarkable in all the patients even with manual burr. There were no major vestibular complications in any of these patients. The study has shown that the significant post-operative hearing results can be still achieved with meticulous surgery by an experienced surgeon with manual burr in the present laser era.

Results of CO2 laser stapedotomy with Teflon piston prosthesis and autologous blood seal.

OBJECTIVE: To study the hearing results and complications in otosclerotic patients who underwent Carbon dioxide (CO2) laser stapedotomy using Teflon piston prosthesis and autologous blood seal. MATERIAL AND METHOD: The charts of all primary CO2 laser stapedotomy procedures performed at Bangkok Metropolitan Administration Medical College and Vajira Hospital between 1997 and 2005 were reviewed. Patients who used Teflon piston prosthesis and autologous blood seal and had follow-up data of more than one year were selected for inclusion in the study. Any patients who underwent CO2 laser stapedotomy for diseases other than otosclerosis or those with inadequate postoperative data were excluded. The hearing results from preoperative and postoperative (most recent follow-up) periods were analyzed using closure of air-bone gaps and postoperative sensorineural hearing loss (SNHL) at pure-tone average (PTA) and different frequencies. Major complications were recorded. RESULTS: The present review yielded 73 primary CO2 laser stapedotomy procedures performed between 1997 and 2005, and 36 patients who underwent 40 CO2 laser stapedotomies met the criteria for analysis. The hearing outcomes were followed for an average of 22 months. The average preoperative and postoperative PTA air-bone gaps were 32.7 and 7.5 dB, respectively. The rate of patients who had postoperative PTA air-bone gaps within 10 dB was 77.5% and within 15 dB was 95%. There was a significant closure of air-bone gaps at PTA and at all frequencies (the frequencies from 0.5 to 4 kHz) and the closures of air-bone gaps at 0.5, 1, and 2 kHz were statistically better than at 4 kHz. The overall rate of postoperative SNHL was 7.5% at high pure-tone bone conduction average. There were no major postoperative complications. CONCLUSION: CO2 laser stapedotomy with Teflon piston prosthesis and autologous blood seal is a safe and effective treatment for otosclerosis. The procedure provides acceptable hearing results and gives the more air-bone gap closure at the low and mid frequency ranges without significant postoperative SNHL and other serious complications.

Otoesclerosis, experiencia quirúrgica 1982-1991 / Otosclerosis, surgical experience 1982-1991

Se presenta la casuística de 157 pacientes con otoesclerosis intervenidos quirúrgicamente por el primer autor; en un lapso de diez años 1982-1991, en el Servicio de Otorrinolaringología del Hospital General de México S.S. bajo la técnica de estapedectomía, utilizando prótesis de House y de Schuknecht. Se practicó estudios clínicos, audiológicos y de imagen, se analizan los resultados y se dan conclusiones.