ABSTRACT
OBJECTIVES: To determine the incidence of middle ear abnormalities in patients with bilateral otosclerosis, which could potentially affect successful stapedectomy, and the rates of success in these patients, including the chance of overclosure in the second ear. STUDY DESIGN: Retrospective case review of operative and audiologic records. SETTING: Private otology practice. PATIENTS: One thousand eight hundred patients underwent 3,600 primary stapedectomies for bilateral otosclerosis. INTERVENTION: Analysis of perioperative and follow-up audiograms with associated operative findings, including obliterative otosclerosis and solid footplates, dehiscent or overhanging facial nerve, narrow oval window niche, promontory overhang, and ossicular fixation or malformation. MAIN OUTCOME MEASURES: Audiologic stapedectomy success was determined as overclosure or closure of preoperative air-bone gap to less than 10 dB at 1 year or more of follow-up. RESULTS: The rate of finding any abnormality was 25%. Abnormalities present bilaterally were found in 135 patients (7%), with otosclerosis requiring an oval window drillout as the most common finding (41%), followed by dehiscent or overhanging facial nerves (25%). Success in patients with abnormalities was 78% overall, with bilateral overclosure in 40%. CONCLUSIONS: Abnormal middle ear findings during stapedectomy occur in a significant percentage of patients. Reasonable rates of success and overclosure can still be expected, but this is somewhat finding-specific. The predictive value of these findings, the associated rates of success with potential impact on surgical counseling, and planning for the "other ear" are discussed.
Subject(s)
Ear, Middle/surgery , Otosclerosis/surgery , Stapes Surgery/methods , Ear Ossicles/abnormalities , Ear Ossicles/surgery , Ear, Middle/pathology , Facial Nerve/pathology , Follow-Up Studies , Humans , Otosclerosis/diagnosis , Oval Window, Ear/surgery , Predictive Value of Tests , Retrospective Studies , Surgical Wound DehiscenceABSTRACT
One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported as successful in 70% to 80% of cases at 1 year. Little is written about long-term results or the association of erosion with various prostheses. We evaluated 83 cases from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was performed with the patient under local anesthesia, with the use of the Lippy modified prosthesis. Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none worse. At 10 years, success had declined to 50% (7 of 14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21 of 23), dropping to 86% at 10 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24 of 70), a plastic strut in 23%, and a Robinsion prosthesis in 17%. We conclude that the risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis yields good long-term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.
Subject(s)
Hearing/physiology , Incus/surgery , Ossicular Replacement/adverse effects , Stapes Surgery/methods , Adolescent , Adult , Aged , Anesthesia, Local , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Ossicular Prosthesis , Osteonecrosis/etiology , Osteonecrosis/surgery , Plastics , Prosthesis Design , Prosthesis Failure , Reoperation , Retrospective Studies , Risk Factors , Surface Properties , Treatment OutcomeABSTRACT
We have investigated the influence of temperature, acute global ischemia, adenosine administration, and alterations in perfusion pressure on the coronary circulation of isolated, perfused spontaneously beating hearts from hibernating, normothermic, and cold-acclimated (nonhibernating) hamsters. No differences in heart rates were observed among groups at either 9 or 38 degrees C. Hearts from hibernating hamsters showed some differences in autoregulatory capacity at both the low and normal temperatures. All hearts exhibited similar responses to 30 s of global ischemia at both temperatures, with a marked reduction in the response at 9 degrees C. Similarly, the magnitude of the vasculature response to adenosine (250 micrograms) at 38 and 9 degrees C was equal in both normothermic and hibernating hearts perfused at 38 degrees C. Responses were abolished in all groups at 9 degrees C. We conclude that the altered ability of hibernating hearts to autoregulate is possibly due to intrinsic differences initiated by hibernation, while the responses to adenosine, and global ischemia are largely temperature-dependent effects.
