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.

Estapedotomía con abordaje totalmente endoscópico para el manejo de otoesclerosis: experiencia de un hospital en Bogotá / Total endoscopic stapedotomy for otosclerosis: the experience of a hospital in Bogota

Objetivo: describir la experiencia en el manejo quirúrgico de la otoesclerosis con estapedotomía totalmente endoscópica en el Servicio de Otología del Hospital Infantil Universitario de San José en Bogotá, entre enero 2017 y diciembre 2018. Métodos: estudio descriptivo de serie de casos con recolección prospectiva, en el cual se evaluaron los pacientes con diagnóstico de otoesclerosis manejados con estapedotomía endoscópica para determinar hallazgos audiológicos prequirúrgicos, detalles de técnica quirúrgica, desenlace auditivo y complicaciones. Resultados: se incluyeron 10 pacientes con otoesclerosis manejados con estapedotomía totalmente endoscópica. La mediana del GAP aero-óseo (GAO) preoperatorio fue 22,4dB (RIQ 15,6-28,3), logoaudiometría con mediana de discriminación del lenguaje al 100% a 72,5dB (RIQ 67,5-77,5). GAO postoperatorio (POP) de 5,3db (RIQ 3,87-6,61), una mediana de logoaudiometría al 100% de 50dB (RIQ 46,25- 61,25). El 90% de pacientes requirió movilización del nervio cuerda del tímpano, ninguno con sección del mismo. El 90% requirió fresado de la pared posterosuperior. El 30% presentó procidencia del nervio facial grado 1. El 30% presentó disgeusia en el POP temprano que persistió en dos pacientes a los 3 meses POP. El 60% presentó vértigo en el POP inmediato, todos con resolución a los 3 meses. Ningún paciente presentó dolor en el POP inmediato, solo un paciente presentó dolor leve a los 8 días. Conclusión: la estapedotomía totalmente endoscópica para el manejo de la otoesclerosis, ha demostrado ser una opción terapéutica segura con alta tasa de éxito, mejoría auditiva con un cierre GAO exitoso y bajo riesgo de complicaciones.

Objective: to describe the experience in the surgical management of otosclerosis with total endoscopic stapedotomy in the Otology Department of the Hospital Universitario Infantil de San José in Bogotá, between January 2017 and December 2018. Methods: descriptive case series. Patients diagnosed with otosclerosis who were managed with endoscopic stapedotomy were evaluated to determine preoperative audiologic testing, details of the surgical technique, auditory outcomes and complications. Results: ten cases of otosclerosis managed with endoscopic stapedotomy were included. The median preoperative air-bone gap (ABG) was 22,4 DB (IQR 15.6-28.3) and in the speech audiometry the median speech discrimination was 100% at 72.5 dB (IQR 67.5-77, 5). The postoperative ABG was 5.3 dB (IQR 3,87- 6,61) and in the speech audiometry the median speech discrimination was 100% at 50 dB with a (IQR 46.25-61.25). 90% of the patients required mobilization of the corda tympani nerve and none required section of it. 90% required drilling or curettage of the scutum. 30% presented with grade 1 facial nerve prolapse. 30% presented disgeusia, 60% immediate postoperative vertigo with resolution at 3 months and no patient presented pain in immediate postoperative. Conclusion: endoscopic stapedotomy for the management of otosclerosis has proven to be a safe treatment option with high success rates, auditory improvement with a successful ABG closure and low risk of complications.

Does stapes surgery improve tinnitus in patients with otosclerosis? / A estapedotomia melhora o zumbido em pacientes com otosclerose?

Abstract Introduction: Otosclerosis (OS) is the primary disease of the human temporal bone characterized by conductive hearing loss and tinnitus. The exact pathogenesis of tinnitus in otosclerosis patients is not known and factors affecting the tinnitus outcome in otosclerosis patients are still controversial. Objectives: To find the effect of stapedotomy on tinnitus for otosclerosis patients. Methods: Fifty-six otosclerosis patients with preoperative tinnitus were enrolled to the study. Pure tone average Air-Bone Gap values, preoperative tinnitus pitch, Air-Bone Gap closure at tinnitus frequencies were evaluated for their effect on the postoperative outcome. Results: Low pitch tinnitus had more favorable outcome compared to high pitch tinnitus (p = 0.002). Postoperative average pure tone thresholds Air-Bone Gap values were not related to the postoperative tinnitus (p = 0.213). There was no statistically significant difference between postoperative Air-Bone Gap closure at tinnitus frequency and improvement of high pitch tinnitus (p = 0.427). There was a statistically significant difference between Air-Bone Gap improvement in tinnitus frequency and low pitch tinnitus recovery (p = 0.026). Conclusion: Low pitch tinnitus is more likely to be resolved after stapedotomy for patients with otosclerosis. High pitch tinnitus may not resolve even after closure of the Air-Bone Gap at tinnitus frequencies.

Resumo Introdução: Otosclerose (OS) é a principal doença do osso temporal humano caracterizada por perda auditiva condutiva e zumbido. A patogenia exata do zumbido em pacientes com otosclerose não é conhecida e fatores que afetam o desfecho de zumbido em pacientes com otosclerose ainda são controversos. Objetivos: Encontrar o efeito da estapedotomia sobre o zumbido em pacientes com otosclerose. Método: Foram incluídos no estudo 56 pacientes com otosclerose com zumbido pré-operatório. Os valores médios tonais do gap aero-ósseo, o tom de zumbido no pré-operatório, o fechamento do gap nas frequências dos zumbidos foram avaliados quanto ao seu efeito sobre o desfecho pós-operatório. Resultados: O zumbido em tom grave teve desfecho mais favorável em comparação com o zumbido agudo (p = 0,002). Os valores médios dos gaps pós-operatórios não foram relacionados com o zumbido pós-operatório (p = 0,213). Não houve diferença estatisticamente significativa entre o fechamento pós-operatório do gap na frequência do zumbido e melhoria do zumbido de tom agudo (p = 0,427). Houve diferença estatisticamente significativa entre a melhoria no gap nas frequências do zumbido e recuperação do zumbido de tom mais grave (p = 0,026). Conclusão: O zumbido de tom mais grave parece ser mais bem resolvido depois de estapedotomia em pacientes com otosclerose. O zumbido de tom agudo pode não desaparecer, mesmo após o fechamento do gap nas frequências do zumbido.

Resultados de estapedotomía en el tratamiento de otosclerosis: serie de casos / Stapedotomy results in The treatment of otosclerosis: number of cases

La otosclerosis es una enfermedad que envuelve la capsula ótica y puede causar desmineralización y cambios otoespogióticos que conducen a hipoacusia conductiva progresiva con afectación particular en las frecuencias bajas (500- 2000 Hz). Tiene una herencia autosómica dominante con penetrancia incompleta. La incidencia se estima en 6.1 casos por cada 100 mil habitantes. Las mujeres se afectan más que los hombres (65% vs. 35%), la mayoría de los casos ocurren entre la segunda y tercera décadas de la vida, el embarazo puede acelerar el proceso otoesclerótico y el cuadro suele ser bilateral en el 60% de los pacientes [1, 2]. La cirugia es el método de elección en el tratamiento de la otosclerosis. Tanto la estapedectomía o estapedotomía son los procedimientos preferidos, siendo la segunda el procedimiento más frecuentemente utilizado por conllevar menos complicaciones quirúrgicas [3, 4]. Algunos estudios han reportado umbrales óseos estables después de la cirugía, mientras que otros muestran una pérdida auditiva neurosensorial de diversos grados a lo largo de años [5 ­ 10]. El objeto de este estudio fue evaluar la mejora auditiva mediante su promedio pre y post cirugía, así como valorar la disminución del gap en los pacientes sometidos a estapedotomía en el Hospital Vozandes Quito

Otosclerosis is a disease that involves the otic capsule and can cause demineralization and otoespogetric changes that lead to hearing loss progressive conductive with particular affectation in the low frequencies (500- 2000 Hz). It has an autosomal dominant inheritance with incomplete penetrance. The incidence is estimated at 6.1 cases per 100 thousand inhabitants. The women affect more than men (65% vs. 35%), most cases occur between the second and third decades of life, pregnancy can accelerate the process Acrosclerotic and the picture is usually bilateral in 60% of patients [1,2]. Surgery is the method of choice in the treatment of otosclerosis. So much Stapedectomy or stapedotomy are the preferred procedures, being the second is the most frequently used procedure because it entails less surgical complications [3, 4]. Some studies have reported bone thresholds stable after surgery, while others show a hearing loss neurosensory of varying degrees over years [5-10]. The purpose of this study was to evaluate the auditory improvement by means of its pre and post-surgery, as well as assessing the decrease in the gap in patients undergoing Stapedotomy at Vozandes Hospital Quito

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.

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.