Subject(s)
Cholesteatoma, Middle Ear/surgery , Fistula/surgery , Labyrinth Diseases/surgery , Otorhinolaryngologic Surgical Procedures/methods , Adult , Aged , Cholesteatoma, Middle Ear/complications , Ear, Inner/surgery , Female , Fistula/etiology , Hearing Loss, Sensorineural/etiology , Hearing Loss, Sensorineural/prevention & control , Humans , Labyrinth Diseases/etiology , Male , Middle Aged , Otorhinolaryngologic Surgical Procedures/adverse effectsABSTRACT
OBJECTIVES: To present our personal experience of a series of 10 patients suffering from tympanosclerosis with functional blocking of the stapes or footplate, who underwent malleostapedotomy surgery. The criteria for patient selection for this type of operation, and its results and complications, are discussed. METHODS: Prospective study. RESULTS: Incus and malleus dysfunction was observed in 70 per cent of cases, either alone or combined with fixation of the stapes. The post-operative hearing results were considered to be satisfactory (i.e. within 20 dB) in 80 per cent of cases. Only one patient had sensorineural hearing loss over 10 dB. CONCLUSIONS: Malleostapedotomy has proved its practicability in the treatment of patients with fixed footplate or stapes complicated by ankylosis of the incudomalleolar joint. This procedure can be considered a further, valid technique within the otologist's surgical armamentarium.
Subject(s)
Malleus/surgery , Otosclerosis/surgery , Stapes Surgery/methods , Aged , Ankylosis/complications , Ankylosis/surgery , Bone Conduction , Female , Hearing Loss, Conductive/etiology , Hearing Loss, Conductive/physiopathology , Hearing Loss, Conductive/surgery , Humans , Incus/physiopathology , Male , Malleus/physiopathology , Middle Aged , Otosclerosis/complications , Otosclerosis/physiopathology , Patient Selection , Prospective Studies , Treatment OutcomeABSTRACT
AIM: To establish if the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of the vestibule, after the removal of vestibular schwannoma by a modified translabyrinthine approach, correlate with a successful outcome, defined as hearing preservation. MATERIALS AND METHODS: Our study group consisted of 16 patients with vestibular schwannoma. All patients' pre-operative hearing was graded as class one or two according to the Gardner-Robertson scale. On MRI scans, the schwannoma, including the intracanalicular segment, were less than 2 cm in size in all the patients. The intracanalicular portion involved the fundus of the internal auditory canal in seven patients. In the remaining nine patients, the schwannoma had spread to involve two-thirds of the meatus, sparing its lateral third. The state of the labyrinth, in particular the integrity of the vestibule, was evaluated by CT scans and MRI prior to and following surgery. RESULTS: The schwannoma was completely removed in all patients. None showed any signs of persistence or tumoral relapse on the post-operative MRI. The final follow up showed that seven patients had maintained their hearing function (i.e. four patients with class one hearing and three with class two). The MRI vestibular signal on the T2-weighted images was well depicted only in patients with hearing preservation. Bony vestibular integrity was observed in the CT scans of all cases with hearing preservation, and also in three cases with failure of hearing preservation. CONCLUSION: Our results confirm that total isolation and maintenance of an anatomically intact vestibule, as depicted by MRI examination, is one of the fundamental factors for successful preservation of hearing function following modified translabyrinthine approach schwannoma removal.
