Comparative study of surgical effects on patients with mixed deafness and otosclerosis with different air bone conduction differences / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the surgical efficacy of patients with mixed hearing loss and otosclerosis with different air bone gap (ABG) before surgery, and to provide reference for the prognosis evaluation of otosclerosis surgery. Methods: The clinical data of 108 cases(116 ears) of otosclerosis who had undergone stapes fenestration technique artificial stapes implantation in Xiangya Hospital of Central South University from November 2013 to May 2020 and had mixed hearing loss before surgery were collected, including 71 women(76 ears)and 37 men (40 ears), with an average age of 38.5 years. According to preoperative pure tone audiometry ABG, they were divided into three groups: group S, 15 dB≤ABG<31 dB, a total of 39 ears; group M, 31 dB≤ABG<46 dB, a total of 58 ears; and group L, ABG≥46 dB, 19 ears in total. The hearing outcomes of three groups of patients at 6-12 months after surgery were compared and analyzed using SPSS 24.0 statistical software. Results: A total of 3 patients (group S: 2 cases; group L: 1 case) experienced severe sensorineural hearing loss after surgery and were not included in the statistical analysis. After surgery, the pure tone hearing threshold of patients with otosclerosis in each group was significantly improved compared to before surgery, with an average air conduction threshold improvement of(21.6±13.4) dB. The difference between before and after surgery was statistically significant(t=17.13, P<0.01). The average bone conduction threshold improved by(3.7±7.6) dB, and the difference was statistically significant before and after surgery(t=5.20, P<0.01). The postoperative ABG was(18.3±9.3) dB, which was significantly reduced compared to preoperative(36.2±8.6)dB. Among the three groups of patients, the L group had the highest improvement in air conduction threshold[(29.9±10.8)dB], while the S group had the lowest improvement[(15.7±11.4)dB]. There was no statistically significant difference in post operative pure tone hearing thresholds between the three groups(P>0.05). The postoperative ABG in group S was the smallest[(16.5±9.0)dB], while in group L, the postoperative ABG was the largest[(20.5±10.0)dB]. Compared with group S, group M and group L still had a large residual ABG at 2 000 Hz after surgery. The bone conduction threshold of both S and M groups improved to some extent after surgery compared to before (P<0.01). Conclusions: Surgery can benefit patients with mixed hearing loss and otosclerosis with different preoperative ABG. Patients with small preoperative ABG have better surgical results and ideal ABG closure at all frequencies after surgery. Patients with large preoperative ABG can significantly increase the gas conduction threshold during surgery, but certain frequencies of ABG may still be left behind after surgery. The improvement effect of surgery on bone conduction threshold is not significant. Patients should be informed of treatment methods such as hearing aids based on their actual situation for selection.

Juvenile otosclerosis: radio-clinical features and outcomes of surgical treatment

Purpose: To review the radio-clinical features and to evaluate the outcomes of surgery approaches for the treatment of otosclerosis in pediatric population. Methods: It's a retrospective study including 12 patients under 18 years of age, diagnosed with otosclerosis and using data over a 24 ­ year ­period (1996-2020). A clinical examination, an audiometric assessment and a computed tomography of the temporal bone (CT-Scan) prior to surgery had been performed in all cases. All patients underwent surgical treatment under general anesthesia. Follow ­up was essentially clinical and audiometric with a mean period of 4years. Results: Mean age of our patients was 15.3 with a ratio of 0.5. Only three of them had a family history of otosclerosis. Major functional sign was hearing loss; tinnitus was noted in only 5 cases. CT-Scan had shown typical radiographic evidence of otosclerosis grade Ia (Veillon classification) in 9 cases, grade Ib in 1 case and no abnormalities in 2 cases. Surgery was performed in all cases: 8 patients underwent stapedotomy and 4 had stapedectomy. The audiometric results were good, air-bone gap closure to within 10 dB was achieved in 84% of cases (10 cases) and to within 20dB in 100% of cases at last follow-up. Conclusion: Audiometric and radiological assessments are essential to guide the diagnosis and the treatment of juvenile otosclerosis. Stapes surgery is a good option for closing the air-bone gap in children with bilateral juvenile otosclerosis

Juvenile otosclerosis: radio-clinical features and outcomes of surgical treatment

Purpose: To review the radio-clinical features and to evaluate the outcomes of surgery approaches for the treatment of otosclerosis in pediatric population. Methods: It's a retrospective study including 12 patients under 18 years of age, diagnosed with otosclerosis and using data over a 24 ­ year ­period (1996-2020). A clinical examination, an audiometric assessment and a computed tomography of the temporal bone (CT-Scan) prior to surgery had been performed in all cases. All patients underwent surgical treatment under general anesthesia. Follow ­up was essentially clinical and audiometric with a mean period of 4years. Results: Mean age of our patients was 15.3 with a ratio of 0.5. Only three of them had a family history of otosclerosis. Major functional sign was hearing loss; tinnitus was noted in only 5 cases. CT-Scan had shown typical radiographic evidence of otosclerosis grade Ia (Veillon classification) in 9 cases, grade Ib in 1 case and no abnormalities in 2 cases. Surgery was performed in all cases: 8 patients underwent stapedotomy and 4 had stapedectomy. The audiometric results were good, air-bone gap closure to within 10 dB was achieved in 84% of cases (10 cases) and to within 20dB in 100% of cases at last follow-up. Conclusion: Audiometric and radiological assessments are essential to guide the diagnosis and the treatment of juvenile otosclerosis. Stapes surgery is a good option for closing the air-bone gap in children with bilateral juvenile otosclerosis

Experiencia en estapedostomías en Hospital del Salvador entre 2012 y 2018 / Stapedotomy experience at Hospital del Salvador between 2012 and 2018

INTRODUCCIÓN: La otoesclerosis es una enfermedad de presumible origen metabólico que determina la fijación de la cadena osicular. La estapedostomía con instalación de prótesis es la cirugía de elección en la actualidad para esta patología. OBJETIVO: Describir experiencia y resultados del tratamiento quirúrgico de pacientes con otoesclerosis en el Hospital del Salvador entre los años 2012 y 2018. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes intervenidos quirúrgicamente en nuestro servicio desde enero de 2012 hasta septiembre de 2018 con sospecha de otoesclerosis. RESULTADOS: Se realizaron en total 52 cirugías a 45 pacientes, 40 vía microscópica, 10 vía endoscópica y 2 mixtas, se utilizaron dos modelos de prótesis, Schuknecht - type piston and wire y Stapes-Prothesen. El promedio tonal puro (PTP) por vía aérea prequirúrgico fue de 65 dB, con una diferencia ósea-aérea (gap) promedio de 36 dB. El PTP promedio posquirúrgico fue de 35 dB con gap promedio de 9 dB, logrando en promedio una mejoría de 31 dB en la vía aérea y 27 dB de cierre de gap. El 92% de los pacientes intervenidos lograron mejoría con respecto al gap posoperatorio. CONCLUSIÓN: La estapedostomía es una intervención que si bien no está exenta de complicaciones, ha demostrado ser segura y tener buenos resultados auditivos en la mayoría de los pacientes.

INTRODUCTION: Otosclerosis is a presumable metabolic disease that determines ossicular chain fixation. Stapedotomy with prosthesis installation is the surgery of choice for this pathology at present. AIM: To describe the experience and results of the surgical treatment of patients with otosclerosis in the Hospital del Salvador between 2012 and 2018. MATERIAL AND METHODS: Clinical records were reviewed of patients treated surgically in our department from January 2012 to September 2018 with suspicion of otosclerosis. RESULTS: A total of 52 surgeries were performed in 45 patients, 42 via microscopy and 10 via endoscopy, two models of prostheses were used Schuknecht - type piston and wire y Stapes-Prothesen. The pure tonal average (PTP) by pre-surgical air was 65 dB, with an average air gap (gap) of 36 dB. The average post-surgical PTP was 35 dB with an average gap of 9 db, achieving on average an improvement of 31 dB in the airway and 27 dB of gap closure. 92% of the patients who underwent surgery improved with respect to the postoperative gap. CONCLUSION: The stapedotomy is an intervention that although not free of complications, has been shown to be safe and have good hearing results in most patients.

Experiencia en estapedotomía en el Hospital Universitario Clínica San Rafael entre 2018 y 2019 / Experience in stapedotomy at the Hospital Universitario Clínica San Rafael between 2018 and 2019

Objetivo: describir la experiencia de los pacientes llevados a una estapedotomía en el Hospital Universitario Clínica San Rafael en los años 2018 y 2019. Materiales y métodos: estudio descriptivo de corte transversal, en el que se revisaron un total de 32 historias de pacientes intervenidos con una estapedotomía entre los años 2018 y 2019 en el Hospital Universitario Clínica San Rafael. Resultados: entre los años 2018 y 2019 se realizaron 32 estapedotomías, 62 % en mujeres, con una media de edad de 48,1 años, el 54,9 % fueron en el oído derecho; al 84,3 % se le realizó un abordaje transcanal, en el 78,1 % se usó prótesis Clip-pistón, en el 46,8 % se usaron prótesis de 4,75 mm; en el 69,7 % de los casos presentaban hipoacusia moderada preoperatoria, 6 pacientes presentaron vértigo, solo en 1 paciente se presentó Gusher como complicación y 1 perforación timpánica; en el 100 % de los pacientes se encontró un cierre satisfactorio del GAP de la vía aérea y ósea. Conclusión: la estapedotomía es un procedimiento que se realizó de manera exitosa en el Hospital Universitario Clínica San Rafael durante los años 2018 y 2019, teniendo en cuenta los buenos resultados auditivos posoperatorios dados por el cierre de la brecha entre la vía aérea y la vía ósea.

Objective: describe the experience of stapedotomy patients at the Hospital Universitario Clínica San Rafael in the years 2018 and 2019. Material and method: descriptive study in which a total of 32 medical records of patients undergoing stapedotomy between 2018 and 2019 at the Hospital Universitario Clínica San Rafael were reviewed. Results: between 2018 and 2019, 32 stapedotomies were registered, 62% female, with a mean age of 48.1 years, 54.9% in right ear; 84.3 % with transcanal approach, 78.1% Clip-piston prostheses were used, in 46.8 % 4.75 mm prostheses were used; 69.7 % presented moderate preoperative hearing loss, 6 patients presented vertigo, only 1 patient presented a gusher complication and 1 tympanic perforation. 100 % of the patients had a satisfactory air-bone gap closure. Conclusion: stapedotomy is a successful procedure performed at the Hospital Universitario Clínica San Rafael during 2018 and 2019, considering the excellent postoperative auditory results given by the air-bone gap closure.

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.

Degree of tinnitus improvement with stapes surgery - a review / Grau de melhora do zumbido com estapedectomia - uma revisão

Abstract Introduction Otospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically, otospongiosis is characterized by progressive conductive and/or mixed hearing loss and by tinnitus. Objective A review of the last two decades of publications that report the degree of tinnitus improvement with stapes surgery. Methods 125 articles published in the last 20 years mentioning the relationship between otosclerosis and tinnitus. Literature has always shown that the hearing improvement after stapes surgery was the main result sought and found. However, recent articles has reinforced the need for surgery for the tinnitus improvement. The ideal time to assess tinnitus through different scales is in the sixth month post-operative. The estimated average hearing improvement is 93% and tinnitus is 85.52%. Results Summaries of 12 articles were reviewed which fulfilled the search criteria of the survey, and 8 studies were included in the study according the selection criteria. This studies investigating the degree of tinnitus improvement with stapes surgery, using different scales as: tinnitus functional index, visual analog scale, tinnitus functional index and visual analog scale, visual analog scale and "questionnaire asking about tinnitus", Newman's method and Tinnitus Score Advocated by the Japan Audiological Society. The total of the samples of the evaluated articles was of 254 participants. Conclusion We conclude that stapes surgery is effective for the treatment of tinnitus (average improvement is 85.52%), and hearing loss (average improvement is 93%). When deciding about the surgical indication in patients with otosclerosis, the presence and level tinnitus should be considered as well as the level of hearing.

Resumo Introdução A otosclerose é uma osteodistrofia do osso temporal, caracterizada pela reabsorção e neoformação óssea desordenadas em indivíduos geneticamente predispostos. Clinicamente, a otosclerose é caracterizada por perda auditiva progressiva condutiva e/ou mista e por zumbido. Objetivo Uma revisão das últimas duas décadas de publicações que relatam o grau de melhora do zumbido com a estapedectomia. Método Foram analisados 125 artigos publicados nos últimos 20 anos que mencionavam a relação entre otosclerose e zumbido. A literatura sempre mostrou a melhoria auditiva como principal objetivo e resultado da estapedectomia. No entanto, artigos recentes reforçaram a necessidade de cirurgia para a melhoria do zumbido. O momento ideal para avaliar o zumbido através de diferentes escalas é no sexto mês pós-operatório. A melhoria auditiva média estimada é de 93% e a do zumbido, de 85,52%. Resultados Foram revisados resumos de 12 artigos que preencheram os critérios de pesquisa, foram incluídos no estudo 8 artigos de acordo com os critérios de seleção. Este estudo investiga o grau de melhora do zumbido com a estapedectomia, utilizando diferentes escalas: tinnitus functional index, escala visual analógica, tinnitus functional index e escala visual analógica, escala visual analógica e "questionário sobre o zumbido", método de Newman e o Tinnitus Score Advocated, da Sociedade Audiológica do Japão (Japan Audiological Society). O total das amostras dos artigos avaliados foi de 254 participantes. Conclusão Concluímos que a estapedectomia é bastante eficaz no tratamento do zumbido (melhoria média de 85,52%) e perda auditiva (melhoria média de 93%). Ao decidir sobre a indicação cirúrgica em pacientes com otosclerose, a presença e o nível de zumbido devem ser considerados, assim como o nível de audição.

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.

Índice de éxito en cirugía del estribo en el tratamiento de otoesclerosis / Index of success in stapes surgery in the treatment of otosclerosis

Introducción: La otoesclerosis es un padecimiento que ocasiona hipoacusia y es de relativa frecuencia en nuestra región con tratamiento quirúrgico bien establecido e índice de éxito relativamente alto. Objetivo: Determinar el índice de éxito del tratamiento quirúrgico de la otoesclerosis en un tercer nivel de atención. Diseño: Estudio observacional descriptivo de corte transversal. Materiales y Métodos. Se revisaron los expedientes clínicos de los pacientes con diagnóstico de otoesclerosis y manejo quirúrgico con estapedectomía y estapedotomía en el servicio de otorrinolaringología de esta institución de julio 2009 a enero 2011. Resultados: De un total de 56 expedientes revisados en el período de estudio, se encontraron 36 expedientes completos, 61.9% mujeres y 27.1% hombres, con una edad media de 36.7 años; la afección bilateral fue del 80% y unilateral del 20%. Con respecto al síntoma predominante, 62% de los pacientes presentaron sólo hipoacusia y 38% tinitus e hipoacusia, con una duración media de 8.4 años. Los hallazgos audiológicos demostraron una prevalencia de hipoacusia conductiva moderada bilateral en 13 pacientes, severa bilateral en 4 casos, hipoacusia conductiva superficial unilateral en 2, hipoacusia conductiva severa y moderada unilateral con uno en ambos casos e hipoacusia conductiva unilateral superficial en 1. En 21 pacientes, se realizaron 29 cirugías, bilaterales en 10 pacientes, 7 en oído izquierdo y 2 en oído derecho y 2 decidieron no operar. Discusión: Se encontró un índice de éxito quirúrgico mayor del 90%. Conclusión: Los resultados presentados, fueron semejantes a los reportados en la literatura.

Introduction: Otosclerosis is a relatively frequent condition that causes hearing loss in our region. The surgical treatment is well established with stapedectomy and stapedotomy, and its success rate is high. Objective: To determine the success rate of surgical treatment of otosclerosis in a third level of care. Design: Observational, Cross sectional study. Material and methods: We reviewed the clinical records of patients with diagnosis and surgical management with stapedectomy and stapedotomy in the otorhinolaryngology department of this institution from July 2009 to January 2011. Results: Of a total of 56 files reviewed during the study period, 36 complete files were found, 61.9% were female and 27.1% were male, with a mean age of 36.7 years, bilateral affection was found in 80% of the patients and unilateral in 20%. Regarding to the predominant symptom, 62% of the patients had only hearing loss and 38% reported tinnitus and hearing loss, with an average duration of 8.4 years. The audiological findings showed a prevalence of moderate bilateral conductive hearing loss in 13 cases, bilateral severe in 4 cases, unilateral conductive hearing loss in 2, unilateral moderate and severe conductive hearing loss in one case, and unilateral conductive hearing loss in 1. In 21 patients, 29 surgeries were carried out, bilateral in 10 patients, 7 in the left ear and 2 in the right ear and 2 decided not to operate. Discussion: A surgical success rate of more than 90% was found. Conclusion: The results presented were similar to those reported in the literature.

Comparison of Free-Beam- and Fiber-Type CO₂ Laser Delivery Systems in Stapes Surgery

BACKGROUND AND OBJECTIVES: A free-beam-type CO₂ laser, which use a micromanipulator mounted on a microscope as the delivery system, has the merit of not being affected by hand tremor at the time of shooting. However, this delivery system has several disadvantages, including a restricted operation range and a risk of incorrect focusing. A fiber-type CO₂ laser uses a hand-held delivery system and has the opposite merits and demerits. We compared the results of stapes surgery with free-beam and fiber type delivery systems. SUBJECTS AND METHODS: The study enrolled 36 patients who underwent stapedotomy with free-beam- (n=26) or fiber- (n=10) type CO₂ lasers. The air-bone (AB) gap closure, bone conduction (BC) change, and operating time were evaluated. The AB gap closure was calculated by subtracting the preoperative BC thresholds from the postoperative air conduction thresholds. The BC change was calculated by subtracting the postoperative BC thresholds from the preoperative BC thresholds. RESULTS: The mean operating time was significantly (p=0.035) shorter in the fiber-type group (72.5±8.2 min) than in the free-beam-type group (80.5±11.4 min). The mean AB gap closure did not differ significantly (p=0.297) between the free-beamand fiber-type groups (5.8±10.1 and 1.4±6.8 dB, respectively). The mean BC change did not differ significantly (p=0.873) between the free-beam- and fiber-type groups (2.4±6.9 and 2.8±5.3 dB, respectively). The hearing outcomes did not differ significantly between the two groups. CONCLUSIONS: Operating times were significantly shorter using the fiber-type CO₂ laser, while hearing outcomes did not differ significantly between the two groups.

Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air-bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air-bone gap <10 dB, and 196 (93.3%) had a residual air-bone gap ±15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgerymay be performed in educational institutions with the supervision of experienced surgeons.

Vestibulotomy in Congenital Stapes Fixation with Anomalous Facial Nerve / 대한이비인후과학회지

Conductive hearing loss is a condition that can be corrected surgically in most cases. Stapedotomy is usually performed for patients with congenital ossicular anomaly or fixation. However, otologic surgeons have often encountered difficulty due to the complexity of stapes surgery. Moreover, congenital stapes fixation with anomalous facial nerve and oval window absence is an uncommon and dangerous condition. In such cases, vestibulotomy can be a surgical option to prevent facial nerve damage and improve hearing. The etiology can be explained by the embryological development of the middle ear structures. To prevent facial nerve damage and maximize the efficacy of surgery, the surgeon should have knowledge about this disease and take a computed tomography for double check before stapes surgery. We describe a case of congenital stapes fixation with aberrant facial nerve courses, a 15-year-old female who was treated with vestibulotomy and piston wire insertion.

A Case of Superior Semicircular Canal Dehiscence Syndrome with Coexisting Otosclerosis / 대한이비인후과학회지

Superior semicircular canal dehiscence (SSCD) syndrome and otosclerosis have overlapping clinical manifestations that can be difficult to distinguish. Audiovestibular symptoms are caused by noise or straining in SSCD, which is associated with the presence of an air-bone gap that overlaps with the characteristic of otosclerosis. We recently examined a 51-year-old woman presenting with unilateral pulsatile tinnitus and ipsilateral hearing loss in the left ear. Computerized tomography, audiometry and vestibular function test confirmed the diagnosis of ipsilateral SSCD syndrome with coexisting ipsilateral otosclerosis. The patient underwent surgical repair of dehiscence by middle fossa approach and stapes surgery for otosclerosis sequentially. She has not had pulsatile tinnitus postoperatively, and hearing improved with the closure of air-bone gap at most frequencies. In conclusion, when SSCD syndrome and otosclerosis coexist and patient has representative symptoms of both ear pathologies, a sequential surgery can be an effective treatment option.

The treatment of otosclerosis using laser assisted stapedotomy with mini incision in external auditory meatus / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the feasibility of the treatment of otosclerosis using laser stapedotomy with mini incision in the external auditory meatus.@*METHOD@#Thirteen patients(15 ears) with otosclerosis evidence on clinic history. They were all operated using the laser assisted stapedotomy by mini incision in external auditory meatus because of the wide straight canal. Laser resection the tendo musculistapedius and anterior and postrior arch, breaking the articulatioincudostapedia, removing the stapes superstructure, making a hole of 6mm diameter in the rear of stapes footplate by laser drilling, implanting the corresponding length Piston artificial ossicle.@*RESULT@#All the surgeries were successful and the operation time was about one hour. There was only one patient manifested vertigo and nausea after the operation. But the symptoms improved three days later after the expectant treatment. All the incisions were healed in the externals. There was significant difference between the preoperative and postoperative PTA. The air conduct improved in every frequent and the bone conduct improved in 1 kHz, 2 kHz and 4 kHz.@*CONCLUSION@#Laser assisted stapedotomy by mini incision in the external auditory meatus in patients having wide straight canal with otosclerosis can shorten the operation time, minimize the tissue damage, fasten the healing of the incision and reduce the complications postoperatively. In addition, the mini incision is beauty and easy to nurse.

Estapedostomía endoscópica: experiencia en el Hospital del Salvador / Endoscopic Stapedotomy: experience at the Hospital del Salvador

Introducción: La otoesclerosis es una enfermedad metabólica, localizada y primaria del hueso de la cápsula ótica y la cadena osicular. Produce fijación de la cadena y consecuente hipoacusia de conducción. Objetivo: El objetivo del presente trabajo es mostrar la estapedostomía endoscópica como alternativa quirúrgica, y comparar sus resultados con la estapedostomía microscópica. Material y método: Estudio restrospectivo de revisión de fichas clínicas de pacientes intervenidos quirúrgicamente en nuestro servicio desde enero de 2012 hasta de junio de 2014 con sospecha de otoesclerosis. Se obtuvieron un total de 35 pacientes operados, 25 vía microscópica y 10 vía endoscópica. Resultados: El tiempo operatorio promedio fue de 60 y 85 minutos para microscópica y endoscópica, respectivamente. El cierre de diferencia óseo aérea (gap), a los 2 meses, fue de 100% para endoscópica y de 92% para microscópica. Un paciente vía endoscópica y 2 pacientes vía microscópica presentaron disgeusia. Conclusiones: La estapedostomía endoscópica es una alternativa quirúrgica ya que permite una excelente visión y comprensión de la anatomía. Su mayor utilidad es que permite trabajar con mejor exposición en conductos auditivos externos (CAE) estrechos y angulados. También contribuye a disminuir el fresado del CAE con menor daño de la cuerda del tímpano. Sus resultados auditivos son comparables con la técnica con microscopio.

Introduction: Otosclerosis is a metabolic bone disease of the otic capsule and the ossicles. It is a primary disease that may cause fixation of the stape and conductive hearing loss. Aim: To show endoscopic stapedotomy as a surgical alternative, and to compare the results with the stapedotomy using microscope. Material and method: Clinical records were reviewed of patients treated surgically in our department from January 2012 to June 2014 with suspected otosclerosis. 35 patients were obtained, 25 using microscope and 10 using only endoscope. Results: Average operative time was 60 and 85 minutes to microscopic and endoscopic group respectively. Air-bone gap closureat 2 months was 100% for endoscopic and 92% for microscopic surgery. One patient of endoscopic surgery and two patients of microscopic surgery presented postsurgical dysgeusia. Conclusions: Endoscopic stapedotomyis a surgical alternative as it allows an excellent vision and understanding of anatomy; it can be performeddespite a curved and narrow external auditory canal (EAC), with a better exposure. It also helps to reduce the milling of EAC with less damage to the chorda tympani. Hearing result is comparable to the microscope surgery.

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

Clinical analysis of tympanosclerosis: characteristics and treatment / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical characteristics, diagnosis and surgical management of tympanosclerosis.@*METHOD@#The data of 73 patients who underwent surgery for tympanosclerosis were retrospectively analyzed with respects to the clinical characteristics, diagnosis and management.@*RESULT@#Seventy-three patients with tympanosclerosis (involving 73 ears) , including 17 patients with sclerosis of tympanic membrane (type I), 23 patients with fixed Malleus-incus complex (type II), 8 (type III) with fixed stapes, and 25 (type IV) with extensive typannosclerosis. Sclerosis was seen most frequently in the malleus, incus and attic, followed by the tympanic membrane, incudomalleolar joint and other regions. Audiometry was performed for all the patients 1 weeks before and 1 year( the least) after operation, which were (51.70 ± 14.93)dB HL and (36.24 ± 11.58) dB HL respectively, with success rate 83% (61/73).@*CONCLUSION@#Most of the patients suffer from conductive hearing loss. Teatment of the sclerosis around stapes is a key point. Acording to the sites of lesion and hearing level, hearing structures should be reconstructed by the rules of tympanoplasty and stapes surgery.

Delayed Positional Vertigo after Stapes Surgery / 대한평형의학회지

Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.

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.

Avaliação audiométrica após estapedotomia com prótese de titânio do tipo Fisch / Audiometric evaluation after stapedotomy with Fisch titanium prosthesis

Otosclerose é uma doença que provoca fixação do estribo, levando à perda auditiva tipicamente condutiva, corrigida com aparelhos auditivos ou cirurgia de estapedotomia, substituindo o estribo doente por uma prótese. O material mais recentemente utilizado é o titânio e no Brasil há apenas duas próteses comercialmente disponíveis. A prótese de pistão tipo Fisch, da Storz, não possui resultados relatados na literatura. OBJETIVO: Estudo retrospectivo avaliando resultado auditivo após estapedotomia com uso desta prótese. MÉTODO: Usando critérios da Academia Americana de Otorrinolaringologia, comparou-se o gap nas audiometrias pré e pós-operatórias, avaliando-se melhora auditiva. RESULTADOS: O gap pós-operatório em baixas frequências teve média de 12,9 dB, em altas frequências de 5,2 dB (média 9,1 dB), mediana 8,8 dB, mínimo 1,3 dB e máximo 21,6 dB, desvio padrão 5,7 e p < 0,001. Dividindo o resultado conforme o gap pós-operatório a cada 10 dB, em 25 pacientes (75,8%) foi < ou igual a 10 dB, em 32 pacientes (96,9%) foi < ou igual a 20 dB, em 100% dos casos foi < ou igual a 30 dB. CONCLUSÃO: Prótese de pistão tipo Fisch apresenta resultados compatíveis com a literatura, podendo ser usada com segurança como mais uma boa opção para estapedotomia.

Otosclerosis causes the fixation of the stapes and conductive hearing loss, usually corrected with the use of hearing aids or through stapedotomy and the replacement of the involved stapes with a prosthesis. Titanium has been the most recently used material of choice in stapedotomy prostheses. Only two prostheses are commercially available in Brazil. There are no reports in the literature on the Fisch-type Storz titanium stapes piston prosthesis. OBJECTIVE: This retrospective study aims to look into the auditory outcomes of patients submitted to stapedotomy and titanium stapes piston prosthesis implantation. METHOD: The criteria described by the American Academy of Otolaryngology were used to compare pre and postoperative air-bone gaps seen in audiometry tests. RESULTS: The mean low-frequency postoperative air-bone gap was 12.9 dB; the mean high-frequency air-bone gap was 5.2 dB (mean 9.1 dB); median gap was 8.8 dB, with a minimum of 1.3 dB and a maximum of 21.6 dB; standard deviation was 5.7 dB, and p < 0.001. Twenty-five (75.8%) patients had air-bone gaps of 10 dB and under; 32 (96.9%) patients had gaps of 20 dB and under; and all patients had gaps of 30 dB and under. CONCLUSION: The Fisch-type titanium stapes piston prosthesis presented outcomes consistent with the literature and can be used safely in stapedotomy procedures.