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Die Laserstapedotomie sowie der Einsatz des Lasers bei Revisionsoperationen ist durch ihre sichere und schonende Technik zur Standardtherapie der Otosklerose geworden. Ziel der vorliegenden Arbeit war die Langzeituntersuchung der Luftleitungsh��rschwelle nach einer Revisions-Laserstapedotomie unter Nutzung der Ein-Schuss-Technik mit dem CO2-Laser in Kombination mit einem Scannersystem. In vorliegender Studie von 93 Revisions-Laserstapedotomien zeigte sich, dass die CO2- Laserstapedotomie mit der Ein-Schuss-Technik komplikationsarm (0,9%) und zuverl��ssig ist. Zudem zeigte sich postoperativ eine deutliche Besserung der Luftleitungsschwerh��rigkeit. Diese Besserung der Luftleitungsh��rschwelle blieb in den untersuchten Jahren stabil, sodass Patienten von der Operation profitierten. Die h��ufigsten Ursachen einer Revisionsoperation waren Prothesendislokationen, bindegewebige Verwachsungen, totale oder partielle Incusarrosionen und zu lange oder zu kurze Prothesen sowie ��senlockerungen. Unter Einsatz des CO2-Lasers, kombiniert mit einem Scannersystem und einem Mikromanipulator, konnten die oben genannten Ursachen der Revisionsoperation erfolgreich behandelt und damit eine Besserung der H��rleistung erreicht werden. Im Rahmen zuk��nftiger Studien wird sich zeigen, ob die positiven postoperativen H��rergebnisse und die geringe Rate an Komplikationen weiterhin Bestand haben. Zudem werden weitere Untersuchungen von Zweit- und Drittrevisionen Aufschluss dar��ber geben, ob diese Operationsmethode auch in solchen F��llen gute Ergebnisse liefern kann., Laser stapedotomy and the use of lasers in revision surgery has become the standard therapy for otosclerosis due to its safe and sparing technology. The aim of the present study was the long-term investigation of the air conduction hearing threshold after a revision laser stapedotomy using the single-shot technique with the CO2-laser in combination with a scanner system. The analysis of the 93 revision stapedotomy operations showed that the CO2-laser stapedotomy with the One-shot Technique was low in complications (0.9%) and reliable. The improvement of the air conduction hearing threshold remained stable during the investigated years, so that the patients benefited from the operation. The most frequent causes of revision surgery were prosthesis dislocations, connective tissue adhesions, total or partial incusarrosions, prostheses that were too long or too short, and loosened eyelets. By using the CO2-laser combined with a scanner system and a micromanipulator, the above- mentioned causes of the revision operation were successfully treated and thus an improvement in hearing was achieved. Future studies will show whether the positive postoperative hearing results and the low rate of complications will continue. In addition, further investigations by second and third revisions will provide information as to whether this surgical method can also deliver good results in such cases.

Patients with otosclerosis can suffer from different grades of combined hearing loss. In addition to surgery (stapedectomy), conventional hearing aids can be used in the treatment of otosclerosis. In cases of severe conductive components in addition to sensorineural hearing loss, treatment with normal hearing aids can be difficult or impossible. In these patients, implantable hearing systems such as cochlear implants represent a possible alternative. The totally implantable Carina middle ear system can be used in patients with even high-grade sensorineural hearing loss. Based on two exemplary cases, the option of using the Carina system in otosclerosis patients and post-implantation results are reported.Patienten mit Otosklerose leiden unter einer unterschiedlich ausgeprägten kombinierten Schwerhörigkeit. Neben operativen Maßnahmen (Stapesplastik) können auch konventionelle Hörhilfen in der Behandlung der Otosklerose eingesetzt werden. Bei stark ausgeprägter Schallleitungskomponente mit zusätzlich bestehendem Innenohrhörverlust kann eine Versorgung mit herkömmlichen Hörgeräten schwierig bis unmöglich sein. Hier stellen implantierbare Hörsysteme wie Cochleaimplantate mögliche Alternativen dar. Dabei kommt dem Carina-System ein neuer Stellenwert zu, da es die Versorgung auch hochgradiger Innenohrhörverluste ermöglicht. Am Beispiel von 2 Kasuistiken wird über die Möglichkeit der Versorgung und die Ergebnisse nach Einsatz des Carina-Implantats bei Otosklerose berichtet.

Die Otosklerose ist eine Erkrankung, die zu einer Verminderung der Beweglichkeit des Steigbügels im ovalen Fenster führt. Die wichtigste Therapiemöglichkeit der entstehenden Schallleitungsschwerhörigkeit besteht in der Stapedotomie. Dabei wird der Steigbügel durch eine Prothese ersetzt, die in ein Loch, das in der Fußplatte geschaffen wird, eintaucht. Für die Methode der Fußplattenperforation stehen drei Verfahren zur Verfügung: Laser, Perforator und Skeeter. Das Ziel dieser Arbeit bestand darin, diese Methoden in Bezug auf das audiologische Outcome zu vergleichen. In dieser retrospektiven klinischen Studie wurden 143 Operationen ausgewertet. 59 Stapesplastiken mit Erbium-Yttrium-Aluminium-Granat- bzw. Kohlendioxid-Laser wurden an der Hals-Nasen-Ohren-Klinik der Universitätsklinik Ulm in den Jahren 2008 bis 2013 durchgeführt. Die 32 Eingriffe, in denen der Perforator und die 52 in denen der Skeeter verwendet wurde, erfolgten in den Jahren 2007 und 2008 in der Klinik St. Salvator Halberstadt. Die Auswertungsgrundlage für das audiologische Outcome bildeten prä- und postoperative Tonaudiogramme. Die Luftleitung hat sich in allen Gruppen, mit Ausnahme von 6kHz in der Laser-Gruppe, signifikant verbessert. Die Knochenleitung ist in der Laser-Gruppe postoperativ pantonal nicht signifikant verändert und in den beiden anderen Gruppen signifikant verbessert. Der Air-Bone Gap (ABG) ist in allen Gruppen und bei allen Frequenzen postoperativ signifikant besser. Im direkten Vergleich der drei Gruppen zeigen sich bei manchen Frequenzen signifikante Unterschiede zwischen den Gruppen bei der Veränderung der Luftleitung und der Veränderung der Knochenleitung. Für den postoperativen ABG, sowie dessen Veränderung konnten keine signifikanten Unterschiede zwischen den Gruppen gefunden werden. Die Erfolgsrate weist ebenfalls keine signifikanten Unterschiede zwischen den Gruppen auf. Die Ergebnisse dieser Studie legen daher nahe, dass weiterhin alle drei Operationsverfahren für die Stapesplastik sehr gut geeignet sind, sodass der Chirurg anhand persönlicher Präferenzen oder eventueller anatomischer Besonderheiten des Operationssitus die Perforationsmethode wählen kann.

After approximately 100 years of development and stepwise improvement, stapes surgery is a succesful strategy of managing hearing loss in otosclerosis, although challanges remain. Contraindications include too poor speech understanding (not enough inner ear reserve), and acute or chronic inflammation of the external ear and middle ear. Stapes surgery in the last hearing ear can today be indicated in exceptional cases, especially if the contralateral ear was supplied with a cochlear implant. In case of simultaneous occurrence of pronounced external auditory canal exostoses, a staged procedure may be useful.The surgical principle is to mechanically replace the fixed stapes with a piston-shaped implant under perforation or partial removal of the stapes footplate. Laser-assisted stapes surgery has proven itself in practice and the laser is used regularly today. In regard to revision surgery the increased risk of hearing loss or deafness and vertigo has to be considered. Revisions are made in the event of complications and persistent or newly occurring conductive components. In the case of insufficient hearing rehabilitation, alternative options should be considered, e. g. the combination of a stapes plastic with an active middle ear implant, or a cochlear implant.Für die – oft in Diagnostik und Therapie anspruchsvolle – Otosklerose kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden. Der erste Teil des Fortbildungsbeitrags umfasste Grundlagen, Diagnostik und Differenzialdiagnostik, im zweiten Teil soll auf therapeutische Aspekte und Nachsorge eingegangen werden.

Otosclerosis is an important condition for the otorhinolaryngologist, and often in (differential) diagnosis and therapy challenging disease. Although a causal therapy option does not exist until today, if the diagnosis is correct, an operative or apparative hearing rehabilitation with very high chances of success can be promised. In addition to hearing aids surgical treatment with passive implants as a standard therapy, and in special cases also the implantation of active middle ear implants or cochlear implants, in advanced otosclerosis with significant involvement of the inner ear, are of importance. Knowledge of the definition, pathogenesis, diagnostics and in particular of the differential diagnosis as well as the current conservative and operative therapeutic limits are indispensable for the indication and selection of the optimal treatment path.In a two-part presentation, the current specialist medical knowledge of the disease in diagnosis and therapy is summarized. In addition to modern diagnostic procedures, aspects of therapy and prognosis are considered in a second article. This article therefore primarily refers to continuing education for residents in training and for young specialists.Die Otosklerose ist eine für den HNO-Arzt/Ärztin wichtige, oft in (Differenzial-)Diagnostik und Therapie anspruchsvolle Erkrankung. Wenngleich bis heute eine kausale Therapieoption nicht besteht, kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden.

Otosclerosis affects health-related quality of life (HRQOL). Until now, measurements have only been performed using audiometric data or non-validated quality of life questionnaires.The objective of this study was to develop the first validated disease-specific HRQOL measuring instrument to determine HRQOL in otosclerosis.After sequential analysis and item reduction of the initial Stapesplasty Outcome Test 47 (SPOT-47), the SPOT-25 was validated prospectively on 52 otosclerosis patients undergoing stapes surgery. In addition to the overall score, four subscores were defined (hearing function, tinnitus, social restrictions, mental condition).The SPOT-25 showed a high internal consistency (Cronbach's α 0.7), allowed discrimination between otosclerosis patients and healthy subjects, and demonstrated acceptable test-retest reliability (r = 0.85). After stapes surgery, the HRQOL improved significantly. The responsiveness was high.The SPOT-25 is the first validated disease-specific instrument for HRQOL measurement in otosclerosis patients. It should be used routinely for quality control.

Einleitung: Die Stapedotomie und im Besonderen die Laserstapedotomie ist in den letzten Jahren zur Standardtherapie der Otosklerose in Primär- und Revisionsfällen geworden. Ziel der vorliegenden Arbeit war die Untersuchung der Sicherheit und Effektivität der berührungslosen Ein-Schuss-Technik mit dem CO2-Laser, kombiniert mit einem Scannersystem, bei Stapesrevisionsoperationen. Methodik: Es erfolgte eine prospektive Untersuchung, Dokumentation in einem Datenbanksystem und statistische Auswertung von präoperativen Symptomen, intraoperativen Befunden sowie Hörergebnissen bei 106 Patienten, die sich im Zeitraum von 1991 bis 2006 einer Revisionsstapedotomie mit dem CO2-Laser an der Klinik für Hals-Nasen-Ohrenheilkunde der Charité Berlin, Campus Benjamin Franklin, unterzogen. Ergebnisse: Die Analyse von 106 Patienten ergab, dass die berührungslose Operationstechnik mit dem CO2-Laser bei der Revisionsstapedotomie zuverlässig und komplikationsarm (0,9%) war sowie regelmäßig zu einer Verbesserung der Luftleitungshörschwelle führte. Ein Einfluss der applizierten kumulativen Laserenergie auf die Innenohrhörschwelle wurde nicht beobachtet. Die am häufigsten beobachteten Ursachen für eine Revision waren dislozierte Prothesen, Incusarrosionen, bindegewebige Verwachsungen, knöcherne Reobliterationen oder eine zu lange bzw. zu kurze Prothese. Unter Verwendung des CO2-Lasers, kombiniert mit einem Scannersystem und einem Mikromanipulator, konnten nachfolgend sowohl massiv obliterierte Fußplatten und dünne Neomembranen als auch mobile Fußplatten ohne mechanisches Trauma erfolgreich perforiert werden. Schlussfolgerung: Es konnte gezeigt werden, dass mit dem neu vorgestellten Operationsverfahren Veränderungen im Bereich der ovalen Nische und der Stapesfußplatte mit einem minimalen Risiko für ein mechanisches Trauma und somit auch für eine Innenohrschädigung vom Bindegewebe befreit werden konnten. Dadurch gelang es, die vorliegende Pathologie eindeutig zu definieren. Im Rahmen zukünftiger Studien wird sich zeigen, ob sich die ermutigenden postoperativen Hörergebnisse und die geringe Rate an Komplikationen bestätigen lassen. Mit zunehmender Zahl an operierten Patienten wird sich auch herausstellen, ob sich der theoretische Vorteil des neu vorgestellten berührungslosen Operationsverfahrens auch in den klinischen Ergebnissen wiederfindet., Introduction: Stapedotomy and in particular laser stapedotomy has recently become the standard treatment for otosclerosis in primary and revision cases. Purpose of this study was to evaluate the safety and efficacy of the one-shot non-contact technique for revision stapes surgery using a CO2-Laser combined with a scanning system. Methods: A prospective study and documentation in a database of pre-operative symptoms, intra-operative findings and analysis of hearing results in 106 patients who underwent revision-stapedotomy with a CO2-Laser from 1991 to 2006 at the ENT-Department of Charité Berlin, Campus Benjamin Franklin was performed. Results: The intraoperative and postoperative analysis of 106 patients showed that the non-touch technique with the CO2-Laser is a reliable surgical technique for cases of revison stapedotomy with a low rate of complications (0.9%) that resulted regularly in an improvement of the air-conduction threshold. An influence of the applied cumulative laser energy on the inner ear hearing threshold was not observed. The most frequently observed causes for revisions were displacement of the prosthesis, incus arrosions, fibrous adhesions and bony reobliteration or a too long or too short prosthesis. Subsequently, by using the CO2-Laser combined with a scanning system and a micromanipulator, massively obliterated footplates, thin neomembranes and mobile footplates could successfully be perforated without mechanical trauma. Conclusion: It could therefore be demonstrated that alterations of the oval niche and the stapes footplate could be freed from connective tissue with a minimal risk for mechanical trauma and inner ear damage by using the newly introduced surgical technique. Thereby, the existing pathology could be defined. Further studies need to demonstrate if these encouraging postoperative hearing results as well as the low rate of complications can be confirmed. With an increasing number of surgically treated patients it will become obvious if the advantage of the new non-touch surgical technique is only a theoretical one or can be clinically confirmed as well.

Microsurgical preparation is limited by geometric and mechanical constraints. In preparation for clinical use, this study investigates performance, ease of handling and precision of a novel manipulator concept for microsurgery.A group of 15 ENT experienced doctors, as well as a group of 17 medical students with low/non surgical experience participated in the study. Each of the subjects carried out 4 trials of simulated surgeries on a phantom with built-in force sensors. The task was to apply a defined force between 1.5 and 2 N using a Fisch micro perforator, 16 cm length, 0.4 mm (Storz) targeting holes with a diameter of 0.5 mm. For comparison, the Fisch micro perforator was moved manually or with the manipulator.Assessing the total number of errors proved a significantly lower error number (p0.0001) and an improvement of the accuracy of 76% with the manipulator. The time requirement for the procedure with the micro manipulator is on average 2-3 times higher than with manual control (p0.0001). But it is notable that this time requirement significantly decreases with training (p0.0001).The study shows a significant reduction in the number of errors by using a new manipulator concept compared to the non-augmented human hand in an experimental setup. We observed a significant learning effect when subjects applied the micro manipulator, resulting in reduction of the time requirement while maintaining a constant number of errors.

Compared to traditional stapes prostheses, self-crimping prostheses have been shown to result in similar, if not better, closure of the air bone gap in patients undergoing stapedotomy for otosclerosis. To achieve self-crimping, nitinol, a shape memory alloy, has been used for several years but concerns have been raised regarding possible damage to the incus and its muco-periosteum. We investigate these concerns with regard to the newer NiTiBOND stapes prosthesis in an observational multi-centre study.In a multicentre, prospective observational study, 76 patients undergoing stapedotomy with the NiTiBond prosthesis across 4 centres were compared to 75 -retrospectively selected control SMart patients. Complications, intra-operative user-friendliness and audiological results at 3 months were documented.Audiological improvement and the rate of complications were similar in both groups. Non inferiority was shown at all frequencies and in the pure-tone average. The NiTiBOND prosthesis was described as very user-friendly.By eliminating manual crimping, stapedotomy using the NiTiBOND prosthesis can be facilitated and standardized. Furthermore, intraoperative handling characteristics of the prosthesis are very good which may further reduce operative risk. Importantly, we show that these benefits are not to the detriment of audiological outcome. Larger and longer-term studies are required to further evaluate results.

The mucosa of the middle ear and the Eustachian Tube changes in different ways when faced with recurrent episodes of inflammation. It thereby adapts to these new stimuli and insults from the environment. One of these changes is the development of MALT (mucosa associated lymphoid tissue). Another adaptation is an alteration of the epithelium. It was therefore the purpose of this study to look for a connection between the occurrence of these changes.90 sections of temporal bones were examined under the light microscope and the incidence of MALT and nature of the epithelium found were compared.Particularly in the middle ear, we demonstrated that in cases where MALT was found within the mucosa, columnar epithelium was frequently found in locations where it is typically rare. Squamous epithelium was in many cases replaced by cuboidal epithelium.We demonstrated that the mucosa of the middle ear changed its morphology towards the characteristics typically found in the upper respiratory tract in cases where MALT had developed as subepithelial lymphoid follicles. It can therefore be concluded that both changes represent the mucosa's reaction to recurrent or chronic inflammation.

This article presents a review of diseases of the temporal bone which are relevant for radiologists in routine clinical practice. First the most prominent imaging methods will be briefly summarized with respect to the current state of the art and the most important aspects of cross-sectional anatomy of the temporal bone will be presented. This is followed by the presentation of various inflammatory diseases. Fractures (longitudinal, transverse and mixed fractures), auditory ossicle lesions and contusions of the labyrinth will be discussed in connection with injuries of the temporal bone. Tumors and tumor-like lesions and the clinical symptoms of otosclerosis and malformations will also be discussed. Finally the postoperative use of imaging methods will be presented. Special importance is given to the position of imaging techniques in the diagnostic chain and their evidential value. This is supplemented by special morphological imaging characteristics and aspects of differential diagnostics.

The anatomical course of the Chorda tympani nerve (CTN) in the middle ear is known to be very variable, which becomes most obvious during middle ear operations. As well, postoperative gustatory dysfunction belongs to the most frequent complications after otosurgical interventions. The aim of this study was to develop a clinical classification of the intraoperatively visible course of the CTN and to demonstrate a possible correlation of its anatomic course with the prevalence of actual postoperative taste disorders.Only cases of first-time ear surgery all operated by one experienced otosurgeon were assessed. Preoperatively, gustatory testing with standardised chemical solutions (sweet, sour, salty, bitter) was performed. During surgery the course of the CTN was classified at first sight by 3 topografical criteria: The angle (A), the height (H) and the depth (D) of the nerve's emergence from the lateral tympanic wall. In cases of postoperative taste dysfunction the patients were followed-up on a regular basis.103 patients were included in the study. The angle of the nerve;s emergence from the tympanic bone was below 30 degrees in 59 (A1), between 30 degrees and 60 degrees in 41 (A2) and within 60 degrees and 90 degrees in 3 cases (A3). The height of emergence was 33 times in the superior (H1), 61 times in the middle (H2) and 9 times in the inferior third (H3) of the posterior meatal wall. The depth of emergence lay within the plain of the tympanic sulcus in 26 individuals (D1), 44 times medially to this plain without overlapping bone (D2) and 33 times medially but covered by a bony spur (D3). The CTN was preserved in 92 procedures. Postoperatively, gustatory function was diminished in 7% of the cases.This study confirms the high diversity of the surgical anatomy of the CTN. According to the proposed classification the A1-H1-D2/3-situation belongs to the CTN-constellations observed most frequently. It is this very anatomical situation, that apparently tends to be associated with postoperative taste deficits quite regularly due to inevitable intraoperative manipulations. Taking into account the results of this study an otosurgeon might be able to anticipate the potential risk for the CTN by judging the AHD-status intraoperatively and - therefore - reduce taste disorders postoperatively. Additionally, the probability of a postoperative gustatory dysfunction depends upon the kind of underlying middle ear disease as well.

Otosclerosis can be of viral origin and in 25-50% of cases a familiar accumulation can be seen. Typically patients develop a progressive middle ear hearing loss which starts in young adulthood and which can affect one as well as both ears in up to 80% of cases. The surgical procedures of choice are stapedotomy and stapedectomy. Complications of surgery are persistent vertigo, secondary facial nerve palsy and the most severe complication is deafness in up to 1% of the cases. Even if the operation risks are low, the alternative use of a hearing aid must be offered in the initial consultation. A new technique of stapes surgery is laser-assisted stapedotomy. Necrosis of the incus process with dislocation of the prosthesis is the most common finding which necessitates stapes revision surgery. The aim of this article is to present the current scientific concept, diagnostics and therapy of otosclerosis with an emphasis on surgical treatment options.

A large variety of prostheses are available for stapes surgery. The newly designed Soft-CliP Piston is an alloplastic prosthesis used in patients with Otosclerosis which has been available since May 2007. With the new design, an intra- and postoperative damage of the ossicle chain should be minimized.A Laser-Stapedotomy was performed in 11 patients with a mean age of 45.7 years. Soft-CliP pistons with a shaft diameter of 0.4 mm and a length of 4.5 mm were used. An accurate examination and an exact audiometric testing were performed pre- and postoperative.The average observed air-bone-gap in the frequencies from 0.5 to 4 kHz was postoperatively in 2.9% of the patients greater than 20 dB, in 5.7% between 15-20 dB, in 14.3% between 10-15 dB and less than 10 dB in 77.1% of the patients. Despite the new design of the prostheses it wasn't possible to slit the prosthesis onto the incus in two cases, and in one case there wasn't the needed size available.A critical point in every stapes surgery, the prosthesis fixation onto the incus, is facilitated by the novel Soft-CliP Piston. Crimping is not needed anymore. Very good hearing results are achieved postoperatively, comparable to other Titanium Prostheses. However the surgeon needs adequate experience to insert the Soft-CliP Piston. Long-term results in a larger group of patients are needed and pending.

CT and MRI of the windows of the temporal bone have become an important tool in the analysis of malformation, trauma and chronic otitis media. Optical Coherence-Tomography (OCT) provides optical cross-sections of the tissue, comparable to ultrasound. In a study on temporal bone specimens and during middle ear surgery we tested, whether OCT provides information about the oval window niche.OCT was performed ex vivo on five human temporal bone preparations, in which the oval window niche was exposed and in vivo in eight patients who underwent middle ear surgery. A new OCT device, which based on spectrally resolved detection of the interference signals, was used. This OCT technology was fully integrated into an operating microscope. For direct correlation between OCT-scans and histology, three temporal bones were used.On all ex and in-vivo scans OCT supplies information about morphology of the stapes footplate. This OCT investigation documents the possibility to visualize in vivo annular ligament, different layers of the FP and inner ear structures.Intra-operative OCT application will help to visualize FP anomalies. Our study provides morphological information of the FP that may help in stapes surgery of the patients concerned.

Tympanosclerosis is a scarring process with a remarkable variability in its localization within the middle ear. It can lead to conductive hearing loss in many cases. It is usually caused by recurrent chronic inflammation of the middle ear. It is generally accepted that functionally relevant tympanosclerotic findings of the middle ear structures should be treated by surgery. Depending on the extent of the surgical resection, the tympanic membrane and the ossicular chain must be reconstructed individually. In cases of isolated myringosclerosis with no hearing loss, no surgery is required. When the ossicular chain is affected by the sclerosis, sound conduction can often be restored only by interposition of grafts. Stapes footplate fixation can be treated by a stapesplasty. Tympanosclerosis of the oval window combined with other chronic inflammation usually requires two-stage surgery. Tympanosclerotic findings without any clinical symptoms should not be removed. The fitting of conventional or implantable hearing aids is the only treatment if chain reconstruction fails or is impossible.

Stapedectomy and, more recently, stapedotomy have been widely accepted as the primary surgical techniques to improve conductive hearing in patients suffering from otosclerosis. Unsuccessful outcomes are infrequent, but revision surgery may become necessary. We have analyzed the value of computed tomography (CT) scanning following unsuccessful stapes surgery.In a total of 37 CT scans, the depth of insertion, angle between prosthesis and footplate, location of prosthesis within the oval niche, visibility of the prosthesis, dehiscence of the superior semicircular canal, and extent of otospongiotic foci were evaluated and compared with the audiometric results.There was no significant correlation between CT parameters and audiologic results, except for patients with cochlear otosclerosis or lateral dislocation of the piston. One previously unknown dehiscence of the superior semicircular canal was diagnosed. Otospongiotic foci were seen in 13 ears (35%).Displacements of the stapes piston and rare causes for an insufficient result, such as a dehiscence of the superior semicircular canal, can be diagnosed accurately by CT. However, correlation between the audiologic results and the findings on CT scans was possible in only a few cases. Nevertheless, CT scans provide additional information for surgical planning in revision stapes surgery and may become increasingly important to reduce unanticipated intraoperative risks; they may even guide the surgeon not to perform unnecessary revision surgeries.

Cochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiological assessment is essential for correctly evaluating the indication for surgery and safely performing cochlear implantation. CT and conventional and functional MRI are available for radiological assessment. Therefore, knowledge of the most frequent congenital syndromal, non-syndromal, and acquired malformations of inner ear structures is fundamental. This article provides information about imaging techniques prior to CI and relevant malformations of the inner ear. Safety aspects for patients with a cochlear implant undergoing MR imaging are also discussed.

Temporary and persistent threshold shifts can occur after ear surgery. So far, only few studies deal with temporary sensory hearing deficits after ear surgery.In a retrospective study, thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz were analysed in 393 patients (125 x mesotympanal chronic otitis media, 164 x cholesteatoma, 44 x tympanosclerosis, 60 x otosclerosis) before, the first 4 days and 3 weeks after ear surgery to evaluate possible temporary threshold shifts.Analysis of all patients in total proved statistically significant slight temporary threshold shifts of up to 7 dB at 2000 Hz (postoperative day 1 to 3) and at 4000 Hz (postoperative day 1 and 2). Use of a drill caused a statistically slight temporary threshold shift only at 2000 Hz at the first postoperative day (4.2 dB). In cholesteatoma surgery with preparations at the ossicular chain a statistically significant slightly higher threshold level was found in all postsurgical evaluations at 500 Hz. Removal of scars or granulation tissue attached to the ossicular chain was not associated with an elevation of threshold levels.Slight temporary threshold shifts can be observed at 2000 Hz and 4000 Hz after ear surgery. Use of the drill and preparation at the ossicular chain usually results in no significant sensory hearing deficit.

The aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMart-Piston).This technique was used in 15 patients (mean age 43.4 years; range 28-71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25-4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery.The median observed air-bone-gap (ABG) postoperatively was 8.7 dB+/-7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB+/-2.4 dB. It was lower than 10 dB in all individuals.A critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.

Using laser in stapedotomy has attracted a lot of attention since the nineties. It aims at minimizing complications due to hand-operated equipment, especially inner ear lesions, and achieving higher precision. We analyzed the clinical effect of Er:YAG laser with the question whether the postulated cochlea protection and foot plate perforation, optimized for better sound conduction, are achieved, compared to conventional stapedotomy.We evaluated retrospectively audiometrical data including pre- and postoperative bone and air conduction thresholds of 114 consecutive patients, on whom we had performed stapedotomy and had inserted platinum-teflon prostheses. The intervention was done conventionally in 72 cases and in 42 cases with Er:YAG laser.In the lower and middle frequencies, laser technique resulted in a more pronounced improvement of bone conduction thresholds compared to conventional stapedotomy. The improvement of air conduction was more distinct in ears after laser surgery; also, the difference between air and bone conduction was reduced at a higher degree.Er:YAG laser in stapedotomy is coupled with cochlea protection, as demonstrated under clinical conditions, and allows higher hearing benefit of air conduction compared to conventional stapedotomy. Our results emphasize the impact of innovative laser technique on stapedotomy.

In order to further optimize the surgical technique with CO(2) laser in stapes surgery, a scanner system was used to obtain a footplate perforation of 0.5-0.6 mm with only one laser application ("one-shot" stapedotomy).A total of 255 patients with otosclerosis were submitted to primary CO(2) laser stapedotomy with a SurgiTouch scanner. This study discusses the surgical technique and clinical results.An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated. In 14% of the patients, a second laser application at the same site was necessary. In 18% the perforation had to be enlarged by several slightly overlapping laser applications without using the scanner. There was no evidence of laser dependent inner ear affections.CO(2) laser, combined with modern scanner systems, is well suited for application in stapes surgery.

Results after cochlear implant surgery may be complicated by postoperative facial nerve stimulation. Aim of the study presented was to evaluate postoperative results in implanting the straight Nucleus electrode array and the preformed Contour array in patients with deafness due to cochlear otosclerosis.A retrospective analysis of intra- and postoperative reports of all patients with cochlear otosclerosis was carried out. Results with the Nucleus straight electrode array and the Contour array were compared with regard to postoperative facial nerve stimulation.None of the Contour patients (n = 7) presented with postoperative facial nerve stimulation. This is in contrast to the majority (4 of 6) of patients being implanted with the straight electrode array. Our results indicate that the use of the Contour array is advantageous in patients being at risk for facial nerve stimulation. In addition intraoperative reports suggest a more reliable insertion of the Contour electrode array in cochlear otosclerosis with partial obliteration.