Diagnosis and management of otosclerosis in a Filipino population: A case series

Objective@#This case series aims to describe the diagnosis and management of otosclerosis in a series of Filipino patients encountered in a private, subspecialty otologic clinical practice. In particular, it elucidates the demographics, clinical presentation, diagnostic exam findings, clinical intervention and hearing outcomes.@*Methods@#Study Design : Retrospective review of medical records of a case series. Setting : Subspecialty otologic / neurotologic clinical practice. Participants : Medical records of all patients diagnosed to have otosclerosis based on radiologic evidence of fenestral or retrofenestral otosclerosis and/or confirmed during surgical exploration of the middle ear, during the period 2004-2017. @*Results@#Nine patients with otosclerosis were identified. Most patients presented with bilateral, primarily conductive hearing loss in middle age. However, an adolescent patient was also identified. Most patients were from the component cities of the National Capital Region. However, patients from the Cordillera region and south-central Mindanao were also identified. Radiologic evidence of fenestral or retrofenestral otosclerosis was identified in the majority of patients. However, readings of normal temporal bone CT findings were also seen. Obliterative otosclerosis was identified in one patient. Both objective and subjective evidence of hearing improvement was documented after stapedectomy in patients undergoing surgery.@*Conclusions@#This study documents the presence of clinical otosclerosis in a Filipino population. As in other populations, it typically presents in middle age as a bilateral, primarily conductive hearing loss. However, a younger age does not preclude its diagnosis, as juvenile otosclerosis has been identified. The presence of patients in regions of the Philippines other than the National Capital Region implies that it has to be considered even in regional populations without a racial predilection for otosclerosis. The identification of radiologic evidence of fenestral and retrofenestral otosclerosis on CT imaging of the temporal bone makes this is an essential part of the work-up of Filipino patients with conductive hearing loss and normal otologic examinations. Surgical treatment via stapes surgery is an effective and viable option in the management of Filipino patients with otosclerosis. The identification of less common variants such as obliterative otosclerosis indicates the need for specialized surgical equipment and appropriate surgical training in order to successfully deal with these situations.

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.

Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose / Computed tomographic factors influencing postoperative audiometric results in otosclerosis

Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

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

Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose

Objectif: Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

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

Fenestral otosclerosis: A subtle lesion easily missed

@#A 29-year-old Filipina of Chinese descent presented with progressive bilateral conductive hearing loss of several years’ duration. While working overseas, she consulted with an otolaryngologist and underwent computerized tomographic (CT) imaging of the temporal bone as part of her evaluation. She was informed that no abnormalities were identified in the imaging exam, and she was offered exploratory middle ear surgery with possible stapes surgery. She then sought a second opinion, with the intention of obtaining a more definitive diagnosis prior to any invasive medical intervention. A review of the CT imaging study, with particular emphasis on looking for radiologic evidence of otosclerosis, revealed the presence of a focal region of bone demineralization in the region of the fissula ante fenestram. (Figure 1) This finding is consistent with a diagnosis of fenestral otosclerosis.

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.

Assessment of inflammatory markers in otosclerosis patients / Avaliação de marcadores de inflamação em pacientes com otosclerose

Abstract Introduction Otosclerosis is an idiopathic disease characterized by new bone formation in foci of the human otic capsule. It is more common in Caucasian populations; affecting females twice as often as males. Its etiopathogenesis has not yet been fully elucidated. Objective The aim of this study was to investigate the relationship between otosclerosis and white blood cell and thrombocyte counts, mean platelet volume, neutrophil lymphocyte ratio, and the platelet lymphocyte ratio. Methods This retrospective case-control study was conducted in the outpatient clinic Mustafa Kemal University, in the department of otolaryngology, between 2015 and 2018. A total of 30 patients with an established diagnosis of otosclerosis were compared to a control group of 30 healthy subjects, matched for age, gender and body mass index. The white blood cell, thrombocyte, mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio values were calculated for all participants. Results There was no statistically significant difference between the groups with respect to age, gender, or body mass index, or for the mean neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell, or thrombocyte values (p > 0.05). A statistically significant difference was determined between the groups for the mean platelet volume values. The mean platelet volume values were lower in the otosclerotic patients (p = 0.047). Conclusion These results show that neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell and thrombocytes should not be used to predict otosclerosis, but suggest that mean platelet volume may be a negative predictive marker.

Resumo Introdução A otosclerose é uma doença idiopática caracterizada por neoformação óssea em focos da cápsula ótica humana. É mais comum em populações caucasianas, afeta o sexo feminino numa taxa 2 vezes maior do que o masculino. A etiopatogenia ainda não foi totalmente elucidada. Objetivo Investigar a relação entre otosclerose e taxa de glóbulos brancos, plaquetas, volume plaquetário médio, relação neutrófilos-linfócitos e relação plaquetas-linfócitos. Método Estudo retrospectivo de caso-controle feito no ambulatório da Mustafa Kemal University, Departamento de Otorrinolaringologia, entre 2015 e 2018. Foram comparados 30 pacientes com diagnóstico estabelecido de otosclerose com um grupo controle de 30 indivíduos saudáveis, pareados por idade, sexo e índice de massa corpórea. Os valores de glóbulos brancos, plaquetas, volume plaquetário médio, relação neutrófilos-linfócitos e relação plaquetas/linfócitos foram calculados para todos os participantes. Resultados Não houve diferença estatisticamente significante entre os grupos em relação a idade, sexo ou índice de massa corpórea, ou em relação aos valores médios de relação neutrófilos-linfócitos, relação plaquetas/linfócitos, valores de glóbulos brancos e plaquetas (p > 0,05). Uma diferença estatisticamente significante foi observada entre os grupos em termos de valores médios de volume plaquetário médio. Os valores de volume plaquetário médio foram menores nos pacientes com otosclerose (p = 0,047). Conclusão A relação plaquetas/linfócitos, a relação plaquetas/linfócitos, os valores de glóbulos brancos e plaquetas não podem ser usados para predizer a otosclerose, mas sugerem que o volume plaquetário médio possa ser um marcador preditivo negativo.

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.

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.

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.

Pedigree Analysis and Audiological Investigations of Otosclerosis: An Extended Family Based Study

BACKGROUND AND OBJECTIVES: To analyse the audiometric profile and the pedigree of a large family with otosclerosis to understand the inheritance pattern and its implication in clinical management of the disease. SUBJECTS AND METHODS: Pedigree analysis was performed on the basis of family history and audiometric tests. Pure tone audiometry, tympanometry, and acoustic reflexes were evaluated for the family members. Audiometric analysis was also carried out for the individuals who have already underwent corrective surgery at the time of study. RESULTS: Out of 112 family members, 17 were affected individuals, and 11 of them were surgically confirmed. Hearing loss (HL) started unilaterally and progressed to bilateral form. Otosclerosis was presented in early 20’s in the first and second generations but it was delayed to mid-late 30’s in the fourth generation. An affected female was diagnosed with otosclerosis during her pregnancy. Though the disease was familial, a mother of four affected offspring in this family did not develop otosclerosis until she died at the age of 84. CONCLUSIONS: The five-generation family, which was analysed in the present study, exhibited autosomal dominant inheritance of otosclerosis with reduced penetrance. Bilateral HL and pregnancy-aggravated otosclerosis were observed in this family. It was found for the first time that the age of onset of the disease delayed in the successive generations. The current study indicated the importance of detailed pedigree analysis for better clinical management of otosclerosis.

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.

Clinical Applications of Wideband Tympanometry / 대한이비인후과학회지

Conventional impedance audiometry uses only specific tympanometric frequencies (e.g., 226 Hz) and cannot test above 1500 Hz. As many hearing frequencies must be evaluated when diagnosing middle ear pathologies, wideband clicks stimulating tympanometric receptors from 226 to 8000 Hz are commonly delivered. Since wideband tympanometry (WBT) was introduced in 1993, several studies have explored its clinical utility. WBT yields information on absorbances at various frequencies and pressures. Recently, WBT has become increasingly used to diagnose and monitor the hearing of newborns and patients with otosclerosis, ossicular chain disruptions, tympanic perforations, superior semicanal dehiscence syndrome, and middle ear effusions. WBT is also employed for pre/postoperative monitoring using non-pressurized wideband absorbance. Here, we review the concept of WBT, the basic mechanism, and the clinical applications.

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.

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)