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BACKGROUND: The study aims to investigate the effect of stapedotomy on audiology measurements and the disease-specific health-related quality of life for patients with otosclerosis using the Danish Stapesplasty Outcome Test-25 as a quality of life measuring tool. METHODS: In this study, 50 patients who had undergone stapedotomy at our department between September 2017 and December 2020 were included. Data collection was performed by audiometric testing (pure tone and speech audiometry) in the pre-and postoperative settings. Health-related quality of life was assessed pre-and postoperatively in 30 patients using the validated Danish Stapesplasty Outcome Test-25. RESULTS: The mean improvement in air conduction thresholds was 27.7 dB and the mean improvement in air-bone gap was 21.8 dB. Health-related quality of life improved significantly after stapes surgery in all subscores of the Stapesplasty Outcome Test-25 (hearing, mental condition, social restriction, and general), except for “tinnitus.” The improvement in the audiometric data correlated significantly with the improvement in “total score” and “hearing function” but not with “tinnitus,” “social restrictions,” and “mental condition.” CONCLUSION: Stapedotomy leads to significant improvement in hearing and health-related quality of life. The Stapesplasty Outcome Test-25 can be used as a valuable supplement to the hearing test by assessing health-related quality of life.

Objectives Stapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post‐operative HF air‐bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency. Methods Retrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre‐ and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz. Results Forty‐six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P

Background Eighteen patients underwent simultaneous bilateral stapes surgery in 2003-2006. Objectives We evaluated the long-term outcomes in this patient group, and assessed their hearing in noise and binaural hearing. Material and Methods Fifteen patients returned questionnaires concerning their hearing, taste function, and balance. Thirteen patients underwent pure-tone and speech audiogram, Finnish matrix sentence test, video head impulse test, and clinical examination on average 13 years after surgery. Results We found no significant difference in air- and bone conduction pure-tone average, speech audiometry, and the air-bone gap between the 1-year and the late postoperative visits. One patient had bilaterally a partial loss of the vestibulo-ocular reflex of unknown cause. Conclusions and Significance The hearing results 13 years after simultaneous bilateral stapes surgery remained good without any significant delayed complications. Simultaneous bilateral stapes surgery is a viable treatment option in selected patients with otosclerosis.

Background: In otosclerosis mixed hearing loss is the most frequent symptom and arises when the focus involves the stapes footplate. Surgeons usually prefer to wait a minimum air-bone gap of 25 – 3...

Objective Stapes surgery is technically challenging, yet its methodology is not standardized. We aim to elucidate preferences in stapes surgery among American Otological Society (AOS) otologists and determine if any common practice patterns exist. Study design Cross-sectional study via emailed questionnaire. Setting Surgery centers. Subjects and methods Members of the AOS were an emailed a survey to quantify variables including surgical volume, anesthetic preference, laser use, type of procedure, footplate sealing technique, antibiotic use, and trainee participation. Results Most otologists (71%) performed 2 to 5 stapes surgeries per month under general anesthesia (69%) with stapedotomy (71%) as the preferred procedure. Most (56%) used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration. Either the handheld potassium titanyl phosphate (KTP) laser (40%) or handheld carbon dioxide (CO2) laser (33%) was used. The heat-activated memory hook (51%) was the preferred prosthesis. Footplate sealing method was variable, as was antibiotic use among respondents. Trainee participation was limited, as 42% of otologists allowed residents to place the prosthesis, and fewer allowed residents to crimp the prosthesis, and laser or drill the footplate. Surgeons with higher surgical volume (≥ 6 surgeries per month) demonstrated the following statistically significant correlations: footplate fenestration with laser in a rosette pattern and pick for debris removal (rs = −0.365, P = 0.014) and trainee participation with fellows only (rs = 0.341, P = 0.022). Conclusions Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

Otosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery.581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted.A statistically significant decrease of postoperative air-conduction thresholds and air-bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values.All the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.Fattori prognostici del miglioramento del gap tra via aerea e via ossea nella chirurgia della staffa.L’otosclerosi è un processo osteodistrofico che interessa la capsula otica e determina un’ipoacusia trasmissiva o mista che può essere trattata chirurgicamente mediante un intervento di stapedotomia. Lo scopo del presente studio retrospettivo multicentrico è l’identificazione di eventuali fattori prognostici correlati a migliori risultati uditivi nella chirurgia della staffa.581 pazienti affetti da otosclerosi sono stati sottoposti a stapedotomia in anestesia locale in due diversi ospedali. Sono state adottate protesi sia in teflon sia in titanio.I nostri dati hanno dimostrato, nel postoperatorio, una diminuzione statisticamente significativa dei valori di soglia per via aerea e del gap tra via aerea e via ossea (ABG), mentre i valori medi della soglia per via ossea risultano sovrapponibili alla condizione preoperatoria. Tra i vari parametri studiati, il materiale della protesi, la durata dell’intervento chirurgico e il rilevamento intraoperatorio di anomalie anatomiche dell’orecchio medio sono risultati correlati a inferiori valori di ABG postoperatorio.Tutti i parametri precedentemente citati svolgono dunque un ruolo significativo nel modificare gli esiti uditivi postoperatori e possono quindi essere considerati fattori predittivi per il successo della stapedotomia.

Purpose of Review This review briefly covers the history of stapedectomy, discusses the indications and problems encountered with revision surgery, and provides case examples with solutions. Recent Findings Revision surgery is challenging and successful outcome even in the most experienced specialists is 45–71%, which is far less than that of primary surgery. Summary Careful evaluation of the reasons for reoperation, anticipation of the common problems, and patient education on reasonable expectations are all very important for success.

Die CO2-Laserstapedotomie ist eine risikoarme und erfolgreiche Operationstechnik bei an Otosklerose erkrankten Patienten. Otosklerose beschreibt einen pathologisch verknöchernden Umbauprozess, der sich in der Labyrinthkapsel im Innenohr und Mittelohr abspielt und eine Schallleitungsschwerhörigkeit verursacht. In der vorliegenden retrospektiven Studie wurden die Daten von 496 Patienten und daraus die von 303 Patienten der HNO-Abteilung der Charité-Universitätsmedizin Berlin seit 1998 ausgewertet. Ziel der Studie war es, die Langzeitergebnisse des postoperativen Air-Bone- Gaps zu analysieren. Nach präoperativer Diagnostik sind die Patienten operiert worden. Der Hörerfolg wurde im postoperativen Verlauf in festgelegten Zeitintervallen mittels Tonschwellenaudiogrammen kontrolliert. Eine beachtliche Verbesserung zeigte der Air-Bone-Gap 1 bis 2,5 Jahre nach der Operation. Dieser verbesserte sich initial bei 97% der Patienten um ≤ 20 dB (0–10 dB bei 67%, 11– 20 dB bei 30%). Nach einem Langzeit-Follow-Up von 7,5 bis 17,5 Jahren zeigte sich eine geringe Verschlechterung auf 85% der Patienten (0–10 dB bei 35%, 11–20 dB bei 50%). In den untersuchten Zeiträumen zeigten nach 17,5 Jahren noch über 85% der Patienten eine verbesserte, postoperativ niedrigere Luftleitungshörschwelle. Bei der Interpretation der Ergebnisse ist allerdings zu beachten, dass die Patientenzahl mit den Untersuchungsjahren abnahm. Diese Langzeitergebnisse nach CO2-Laserstapedotomie legen somit nahe, dass sich der berührungslose Eingriff hinsichtlich der Verbesserung des Hörvermögens langfristig lohnt. Diese Ergebnisse beinhalten lediglich objektivierbare diagnostische Parameter, von Patienten, die regelmäßig an den Nachsorgeuntersuchungen teilnahmen. Die subjektiven Empfindungen der Patienten wurden hier nicht mit einbezogen. Die Lebensqualität spielt allerdings ebenfalls eine wichtige Rolle in der Analyse von Langzeitergebnissen nach einer Laserstapedotomie. Daher sollte dieser Bereich in den nächsten Studien berücksichtigt und vertieft werden., CO2-laser stapedotomy is a low-risk and successful surgical technique in patients suffering from otosclerosis. Otosclerosis describes a pathologically ossified conversion process that takes place in the labyrinth capsule in the inner ear and middle ear and causes a conductive hearing loss. In the present retrospective study, data from 496 patients and 303 patients from the ENT department of the Charité-Universitätsmedizin Berlin have been evaluated since 1998. The aim of the study was to analyse the long-term results of the postoperative air-bone-gap. After preoperative diagnosis, the patients have undergone surgery. Hearing success was controlled in the postoperative course at specified time intervals by means of sound threshold audiograms. The air-bone-gap showed a considerable improvement 1 to 2.5 years after the operation. This initially improved by ≤ 20 dB in 97% of the patients (0–10 dB in 67%, 11–20 dB in 30%). After a long-term follow-up of 7.5 to 17.5 years, there was a slight deterioration in 85% of the patients (0–10 dB in 35%, 11–20 dB in 50%). In the periods examined, over 85% of the patients still showed an improved, postoperatively lower air conduction hearing threshold after 17.5 years. When interpreting the results, however, it should be noted that the number of patients decreased with the years of the examination. These long-term results after CO2-laser stapedotomy therefore suggest that the contactless intervention with regard to the improvement of hearing is worthwhile in the long term. These results only include objectifiable diagnostic parameters from patients who regularly participated in the follow-up examinations. The subjective feelings of the patients were not included here. However, the quality of life also plays an important role in the analysis of long-term results after a laser stapedotomy. Therefore, this area should be considered and deepened in the next studies.

L’impatto dei fattori intra-operatori sul risultato della chirurgia dell’otosclerosi: studio retrospettivo in un centro di terzo livello.Lo scopo dello studio è stato di valutare i risultati ottenuti in un’ampia coorte di pazienti sottoposti a intervento chirurgico per otosclerosi e determinare l’impatto delle variabili intraoperatorie sulla funzione uditiva e sul tasso di complicanze. Abbiamo arruolato 384 pazienti affetti da otosclerosi e sottoposti a intervento chirurgico tra il 2004 e il 2013 in una singola clinica. L’intervento è stato sempre effettuato in anestesia locale e mediante perforatore manuale e/o microdrill. In tutti i pazienti è stata utilizzata una protesi in teflon. I dati audiologici pre-operatori e post-operatori (almeno 12 mesi dopo l’intervento) sono stati confrontati. Le forme di otosclerosi “periferica” e “diffusa” si associavano a migliori risultati funzionali rispetto allo forma “obliterativa” (p0,05). L’Air Bone Gap post-operatorio medio risultava significativamente maggiore nel gruppo in cui era stato utilizzato il pistone con diametro 0,4 mm rispetto al gruppo con pistone 0,6 mm alle frequenze 0,5 kHz (p0,001) e 1 kHz (p0,02); nei pazienti sottoposti a stapedotomia è stata riscontrata una differenza statisticamente significativa tra i gruppi in cui era stato utilizzato il pistone da 0,4 e da 0,6 mm, a favore di quest’ultimo (p0,05). Non sono state riscontrate differenze in termini di soglia uditiva media e di complicanze tra i due gruppi. Le variabili intra-operatorie non sono completamente prevedibili nel pre-operatorio e i nostri dati potrebbero costituire un aiuto nella stratificazione del risultato e come guida per le decisioni del chirurgo.The aim of the study was to assess results from a large cohort of patients undergoing otosclerosis surgery with respect to the impact of intra-operative variables on post-operative hearing function and complications. We enrolled 384 patients affected by otosclerosis who were subjected to stapes surgery between 2004 and 2013 at a single institution. Surgery was performed in all cases under local anaesthesia, using a manual perforator and/or microdrill. Teflon-piston prosthesis was used in all patients. Audiological data obtained preoperatively and at last follow-up examination (minimum 12 months) were compared. Statistical analysis was performed using the multiple regression model. Peripheral rim otosclerosis and diffuse otosclerosis were associated with better functional results compared to the obliterative pattern (p0.05). Mean post-operative Air-Bone Gap was significantly higher in the 0.4 mm, compared to 0.6 mm piston group at 0.5 kHz (p0.001) and 1 kHz (p0.02); in the stapedotomy group a statistically significant difference was found between 0.4 and 0.6 mm piston groups, in favour of the latter (p0.05). No differences were encountered in terms of average hearing threshold and complications. Intra-operative variables cannot be fully predictable and our data could help in stratification of the results and as a landmark for the surgeon’s decisions.

Objective: If mixed-hearing-loss (MHL) occurs in otosclerosis, hearing-aids (HA) in addition to conventional-stapedotomy (SDT) may be necessary. If otosclerosis progresses or technical or medical problems prevent use of HA, combining active-middle-ear-implants (AMEI) with SDT (“power-piston”) may be considered. Previously, AMEI-coupling to the long-incudial-process was suggested. Here, a “modified-power-piston” surgery (mPP) coupling to the short-incudial-process was proposed, so no coupling over the positioned stapes-piston is required. We questioned whether mPP is as safe and effective as SDT. Methods: Otosclerotic patients with MHL and limited satisfaction with previously worn HA receiving mPP were retrospectively reviewed at two Austrian tertiary otologic referral centers. Patients, receiving stapedotomy, were case-matched for preoperative pure-tone averages (PTA), bone-conduction (BC-PTA), air-conduction (AC-PTA), and air-bone gap (ABG-PTA). Postoperative changes in BC-PTA and in AC-PTA and ABG-PTA were defined as safety- and as efficacy outcome parameter. Results: Of 160 patients, 14 received mPP and 14 stapedotomy. Preoperative findings were comparable (all p = 1.000). BC-PTA improved from 38.0 to 36.7 and from 37.1 to 36.9 dB-HL for mPP and SDT, respectively (Δ –1.3 versus –0.2 dB-HL; p = 0.077). AC-PTA improved from 66.8 to 47.1 and from 66.3 to 46.5 dB-HL for mPP and SDT, respectively (Δ –19.6 versus –19.7 dB-HL; p = 0.991). ABG-PTA improved from 28.8 to 10.4 and from 29.1 to 9.6 dB-HL for mPP and SDT, respectively (Δ –18.3 versus –19.5 dB-HL; p = 0.771). Conclusion: In otosclerosis with MHL and limited satisfaction with HA, mPP appeared as safe and effective as SDT and may be considered a treatment alternative in these patients.

Introduction:To evaluate the audiological variables and to investigate the factors affecting hearing improvement in patients who underwent stapedotomy with the diagnosis of otosclerosis.Methods:The data of 114 patients who had middle ear exploration were retrospectively reviewed. Air conduction thresholds between 250-6000 Hz and bone conduction thresholds between 500-4000 Hz were examined in pure tone audiometry. Postoperative air-bone gap (ABG), change in ABG, and change in bone conduction threshold at high frequency were primarily examined. The results of different piston diameters were compared.Results:Eighty-three patients with stapedial footplate fixation were included in the study. While post-operative air conduction thresholds decreased significantly at all frequencies, bone conduction thresholds decreased significantly only at 2000 Hz (p=0.001). The most notable gain in ABG was obtained at 500 Hz. The post-operative air conduction pure tone average was significantly higher in patients with 0.6 mm diameter prosthesis. Postoperative mean ABG and ABG values at 2000 and 4000 Hz were found to be significantly lower in patients with 0.8 mm diameter prosthesis (p

OBJECTIVE Stapedotomy is an effective treatment for conductive hearing loss associated with otosclerosis. However, the procedure, especially using the endoscopic technique requires extensive training and experience for optimal results. Due to limited training options in endoscopic stapes surgery, we aim to develop an ovine stapedotomy model and assess its feasibility for surgeons at different training levels. METHODS A fully endoscopic ovine laser-stapedotomy model was developed and described. During repetitive dissections, surgical time required for the different steps to assess the training curve and associated intraoperative complications were recorded in three surgeons of different training level. Additionally, subjective feedback was assessed. RESULTS Successful endoscopic laser-stapedotomy was performed in 25 cases in the ovine model. Assessment of surgical time revealed a stable curve for the experienced surgeon (mean 15:01���min) for the whole training with no intraoperative complications. The fellow showed a gradual reduction of surgical time from 27:21 (first five cases) to 24:10���minutes (last five cases) and the resident a reduction from 42:38 to 21:08���minutes respectively. The assessed learning curve for the trainees revealed a significant association between the operative time and observed intraoperative complications. DISCUSSION In this study, an ex-vivo model for exclusively endoscopic laser-stapedotomy was developed and tested for feasibility. We suggest the ovine model as a cost-effective, easily available, and realistic training model for future otologic surgeons. The surgeons were able to improve their performance with satisfactory results despite the small number of cases.

To analyze and compare surgical and audiological outcomes of conventional approaches versus laser CO2 surgery in stapes surgery. 333 patients who underwent stapes surgery were enrolled in the study; the patient population was divided into three groups: group 1: 170 patients treated with conventional stapedotomy with manual microdrill (average age 49.13 years); group 2: 119 patients treated with conventional stapedotomy with electrical microdrill (average age 51.06 years); group 3: 44 patients (average age 50.4 years) who underwent CO2 laser stapedotomy. Intra-operative, postoperative outcomes and audiological results were investigated. The average surgical time of laser CO2 surgery was longer than for other surgical procedures. No statistical differences emerged in post-operative abnormal taste sensation. There was also no difference in postoperative dizziness. Air-bone gap (ABG) went down from 29.7 ± 10 dB (group 1) and 27.32 ± 9.20 (group 2) to 10 ± 6.9 dB (group 1) and 10.7 ± 6.03 dB (group 2). In group 3 the preoperative ABG was lowered from 28.3 ± 10.1 to 11.8 ± 10.9, with a statistical difference in auditory recovery (p = 0.0001); The group of patients treated with laser CO2 showed a percentage of patients with an ABG closure of between 0 and 10 dB higher than in the group treated with manual microdrills (77.2% vs. 60%, respectively; p = 0.03). Overall surgical results of CO2 laser and conventional stapedotomy are comparable without any significant difference; however, the group treated with CO2 laser appears to have a percentage of patients with an ABG closure 0–10 dB higher than the group treated using the conventional technique.

Objectives/hypothesis To assess hearing outcomes and complications of endoscopic stapes surgery by a single surgeon in a 10-year period, to compare these data with conventional microscopic procedures by the same operator, and to describe the learning curve of endoscopic stapedotomy. Study design Retrospective study. Methods This is a retrospective study on patients who underwent endoscopic stapes surgery performed by the same senior surgeon, experienced both in microscopic and endoscopic techniques, between January 2009 and December 2018. Audiological data were compared, and intraoperative and postoperative complications were collected. The surgeon's last 30 cases of microscopic stapedotomy were enrolled as the control group. The results of the first 100 endoscopic stapes surgeries were analyzed separately to create a cumulative sum (CUSUM) control chart for learning curve assessment. Results One hundred seventy-eight endoscopic and 30 microscopic stapes surgeries were included. In the endoscopic group, the mean postoperative air-bone gap was 8.2 dB. No significant differences between the endoscopic and microscopic preoperative and postoperative values were reported. A total of eight complications (4.5%) were observed in the endoscopic cohort, although in the control group, no complication occurred. The mean surgical time was 51.9 minutes in the endoscopic group versus 48.2 minutes in the microscopic group (P > .05). No association between stapedotomy success and the increasing number of procedures was found. Conclusions Our article demonstrates that functional results from endoscopic stapes surgery are similar to those from microscopic stapes surgery in terms of both safety and efficacy. After gaining endoscopic experience, the surgical duration of stapes surgery will be adequate starting from the first cases. Level of evidence 4 Laryngoscope, 131:885-891, 2021.

We describe the youngest case of bilateral stapes agenesis and systematically reviewed the literature. Among those cases, 8/12 (66.7%) showed a bilateral agenesis. There is a male predominance 8/12 (66.7%). The most common associated anomaly reported being either a dehiscent or displaced facial nerve (7/12–58%). Furthermore, 5/12 patients (42%) had a narrow or an absent oval window. In our case, a 5-year-old male patient was referred for bilateral conductive hearing loss (air-bone gap 65 dB, bilateral). Operating findings on the left side included an inferiorly displaced facial nerve over the promontory, a narrow ossified oval window and an absent stapes. A stapedotomy with insertion of a modified stapes prosthesis allowed us to close the conductive gap. Even with possible good outcomes, surgical management should not be taken lightly, considering amplification is almost always a safe and effective option.

Objective: The main objectives of the present study were to compare the surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery. Methods: Sixty-one patients who underwent the stapes surgery with the endoscopic and microscopic approach between January 2012-November 2018 were included in the study. Patients were divided into two groups as a Group-I (endoscopic) and Group-II (microscopic). The audiometric measurements, duration of surgery, intraoperative findings and complications were recorded and evaluated retrospectively. Results: Mean operative time for the Group-I and II was 45.1±8.4 minutes and 48.7±5.6 minutes, respectively (p>0.05). The preoperative and postoperative average air-bone gap in the Group-I was 27.8±7.2 dB and 8.7±3.4 dB and these values in Group-II were 30.2±5.1 dB and 7.4±4.8 dB, respectively (p0.05). Conclusion: Endoscopic stapes surgery provides comparable audiological outcomes, shorter operative times, fewer complications rates, and more minimally invasive surgery, relative to the microscopic approach.

Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope. Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis (n = 30) or chronic otitis media (n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope—VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope. Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope. Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.

To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy.WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis.Eight fresh-frozen temporal bones were harvested from human cadaveric donors.At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value0.01). The crimping conditions did not differ from one another (p = 0.555).WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.

ObjectiveThis study aimed to compare the hearing results of two different stapedotomy techniques used in the clinic at different time points.MethodsAn endoscopic surgery group (group 1; n = 37) were compared retrospectively with a microscopic surgery group (group 2; n = 57). A small fenestra and Teflon piston technique were used in all patients. Bone cement was used for fixation between the prosthesis and incus in the endoscopic group only. Bone conduction threshold and air–bone gap were used as the comparison parameters.ResultsThe pre-operative air–bone gap was 31.26 dB in group 1 and 32.51 dB in group 2. The post-operative air–bone gap was 8.93 dB in group 1 and 14.28 dB in group 2. There was a significant difference between the groups in post-operative air–bone gaps. There was no significant difference between the groups in post-operative bone conduction thresholds.ConclusionThe endoscopic technique using bone cement fixation was better for closing the air–bone gap.

INTRODUCTION: Otosclerosis is one of the commonest non infective causes of acquired deafness in adults’. ‘Otosclerosis’ literally means hardening of the ear. It is a primary and exclusive disease of otic capsule of human temporal bone. Otosclerosis is characterised by alternate phases of bone resorption and formation. If the location of bony changes produces evident clinical manifestations term “C linical Otosclerosis” is used. If bony changes are not translated into clinical manifestations, the term used is “histologica l Otosclerosis”. Antonio Valsalva in 1735 gave first description of ankylosis of stapes to margins of oval window. Von Troltsch in 1881 coined the term ‘Otosclerosis’. Politzer in 1893 first described Otosclerosis as a primary disease of otic capsule. Alth ough the clinical course of the disease is well documented, its aetiology remains unclear; thus, multiple theories are available. But none of them has established a definite cause. Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. The clinical diagnosis of Otosclerosis, as clarified by Bezold in 1908, requires a careful history, physical examination, tuning fork evaluation and audiometric testing. Radiographic examinations can be done as adjuncts when needed. Therapeutic options for Otosclerosis include medical, surgical and use of hearing aids, alone or in combination. Stapes surgery is an effective treatment for hearing loss and tinnitus of Otoscl erosis and stapedectomy is the current treatment of choice for conductive component of Otosclerosis. The first stapes mobilization was employed by Kessel in 1878. The procedure of extracting the stapes for Otosclerosis was first performed by Jack of Boston in 1892 but was beset with obvious difficulties because he lacked proper magnification and antibiotic coverage. In 1956 Dr. John Shea revived the stapedectomy operation for Otosclerosis and replaced the stapes bone with a polyethylene tube prosthesis and vein graft. Small fenestra stapedectomy is a more precise method of creating a hole in footplate rather than total footplate removal. It gives less post - operative vertigo and better high frequency hearing compared to total footplate removal. The present st udy is a longitudinal clinical study on Otosclerosis with emphasis on clinical and audiological features, per operative findings, outcome and complications of stapedectomy. The objective is to study the demographic and clinical features of Otosclerosis in this part of Kerala; to analyze the results of audiometry and operative notes of Otosclerosis; to describe the outcome and incidence of complications of small fenestra stapedectomy in Otosclerosis

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.

Objectives: To assess the long-term effectiveness of stapedotomies performed on patients with otosclerosis and preoperative small air-bone gaps (ABGs). Methods: Retrospective study comparing the 10-year postoperative hearing outcomes after primary stapedotomies in patients with small (≤20 dB) and large ABGs (> 20 dB). Ninety out of 175 stapedotomies (22 and 68 in the small and large ABG groups, respectively) were monitored with long-term follow-ups. Results: Ten years after the operation, hearing measurements were similar for both groups, although a significant decline of bone conduction thresholds was evident (p = 0.007 and p < 0.001, respectively). An improvement of ≥10 dB in the postoperative ABG (clinical improvement) was achieved only in the large ABG group. Conclusions: Even though long-term hearing levels will evolve similarly in patients with ≤20 and > 20 dB preoperative ABGs, the lack of clinical improvement found in the small ABG group is not in favor of an early surgery.

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.

Micron is a fully handheld active micromanipulator that helps to improve position accuracy and precision in microsurgery by cancelling hand tremor. This work describes adaptation, tuning, and testing of the Micron system for stapedotomy, a microsurgical procedure performed in the middle ear to restore hearing that requires accurate manipulation in narrow spaces. Two end-effectors, a handle, and a brace (or rest) were designed and prototyped. The control system was adapted for the new hardware. The system was tested ex vivo in stapedotomy procedure comparing manually-performed and Micron-assisted surgical tasks. Tremor amplitude was found to be reduced significantly. Further testing is needed in order to obtain statistically significant results regarding other parameters dealing with regularity of the fenestra shape.

INTRODUCCIÓ L'otosclerosi causa un hipoacúsia de transmissió que augmenta a mesura que avança la malaltia, i que es pot corregir amb un alt percentatge d'èxit amb l'estapedotomia. OBJECTIU Valorar els resultats de la cirurgia si la intervenció es realitza quan la diferència entre llindar de via aèria i via òssia (GAP) és menor a 20dB, i comparar-ho al llarg de 10 anys amb els resultats de les intervencions de GAP major. Valorar factors predictius d'èxit postoperatori a curt i llarg termini. MATERIAL i MÈTODES. S'estudien consecutivament totes les estapedotomies (pistó de Causse) realitzades a l'Hospital Joan XXIII de Tarragona del 1994 al 2000, resultant 175 casos amb una mitjana d'edat de 42,95 (+/-11,27) i predominant les dones en relació 2:1. Es divideixen en 2 grups segons el GAP preoperatori sigui ≤20dB o >20dB. Es realitza el seguiment audiomètric als 3 mesos de la cirurgia, a l'any , als 5 anys i als 10 anys, i es valora el percentatge d'èxit (GAP≤10dB) de tancament de GAP i els valors mitjans de GAP postoperatori obtinguts. RESULTATS La taxa d'èxit al postoperatori als 3 mesos de les estapedotomies amb GAP20 sense diferències estadísticament significatives (p=0,256). Els resultats a 1 any són: 71,86% (8±4,3) vs 63,46% (10,21±6,87) (p=0,377). A 5 anys són: 46,43% (11,47±6,62) vs 47,62% (11,47±6,92) (p=0,913). I als 10 anys els resultats són: és de 45,45% (12,26±4,96) vs 42,65% (12,76±7,58) (p=0,817). No hi ha cap cas de pèrdua total d'audició postquirúrgica. A l'anàlisi multivariant surt com a factor predictor de forma bastant constant l'afectació clínica bilateral, no trobant com a predictors ni l'edat, ni els antecedents familiars ni el GAP preoperatori en cap moment. CONCLUSIÓ L'estapedotomia es pot realitzar amb èxit quan la pèrdua auditiva creï un desconfort evident al pacient, independentment del grau de pèrdua auditiva que tinguem, podent solventar la hipoacúsia, millorant la comunicació verbal i amb resultats satisfactoris del pacient. Sembla que l'afectació clínica unilateral seria una forma d'otosclerosi amb pitjor pronòstic de cara a l'èxit quirúrgic postoperatori, que les formes bilaterals., INTRODUCTION Otosclerosis is the cause of a conductive hearing loss that becomes worse as the disease progresses. It can be successfully treated in most cases through stapedotomy. OBJECTIVE To assess the hearing results following stapedotomies in patients with air-bone gaps (ABG) under 20dB compared with the results of the operation performed on patients with greater ABG, during a 10 year follow-up. To analyze predictive factors for successful surgical outcome both in the short and long terms. MATERIAL AND METHODS Consecutive study of all stapedotomies (Causse piston) performed at Hospital Joan XXIII, Tarragona, between 1994 and 2000. A hundred and seventy-five patients were included, mean age 42.95(± 11.27), sex ratio 1:2. Individuals were divided in two groups according to their preoperative ABG: ≤20dB or >20dB. Postoperative audiometries were performed at 3 months, 1, 5 and 10 years. The ABG closure (≤10dB) percentage and the mean values of postoperative ABG were analysed. RESULTS Rates of stapedotomy success at 3 month postoperative in the ABG ≤20dB and ABG>20dB groups were 65.71% (mean ABG 10±5.54) and 54.26% (mean ABG 11.13±6.53) respectively. Differences were not statistically significant (p=0.256). Results at 1 year: 71.86% (8±4.3) vs 63.46% (10.21±6.87) (p=0.377). At 5 years: 46.43% (11.47±6.62) vs 47.62% (11.47±6.92) (p=0.913). At 10 years: 45.45% (12.26±4.96) vs 42.65% (12.76±7.58) (p=0.817). None of the patients suffered complete hearing loss postoperatively. Bilateral clinical otosclerosis appeared to be a rather constant predictive factor in the multivariate analysis, whereas age, family history and preoperative air-bone gap were not. CONCLUSION Stapedotomy can be successfully performed when hearing loss is an evident cause of discomfort for patients, not related to their degree of loss. Thus, it may restore hearing loss, improve verbal communication and patient satisfaction. Unilateral clinical otosclerosis seems to be a poor prognostic factor for surgical outcome compared with bilateral forms.

CO2-lasers are used by many otosurgeons to perforate the stapes footplate for the treatment of otosclerosis using the “multiple-shots-technique” or the “one-shot technique”. The latter is successful in about 68% of all cases. However, in 78% of revision cases with a reossified footplate, multiple-shots are necessary. The aim of study was to analyze the interdependence of used the CO2-laser used energy and post-operative bone conduction hearing thresholds to assess a possible laser-induced inner-ear damage. A prospective analysis of the influence of cumulative laser energy on post-operative bone conduction hearing thresholds was performed with data from 391 primary cases that were divided in into 261 single-shot and 130 multiple-shots CO2-laserstapedotomies and in 107 in revision cases which were divided in into surgeries operations with simple change of prosthesis (n=35), single-shot perforation of a neomembrane (n=33) and multiple-shots for the perforation of reossified footplates (n=39). Neither after primary nor in revision surgeries surgery significantly different changes in bone conduction hearing levels were found between the different groups that required an energy of 0, 2 J after long-term follow up. In both tested time periods (short-term: 1~3 weeks; long-term: 1.5~6 months) the majority of patients, showed a lower bone conduction threshold which further improved over time. A comparison of study results after stapedotomy available from the literature showed that our data were among the best results. In conclusion, the application of the “one-shot technique” with energy ≤ 1 J impaired inner ear function less than the application of the “multiple-shots technique” during the short-term observation period. After long- term follow-up the influence of the total laser energy used during CO2-laser stapedotomy performed as primary or revision surgery using the one-shot or multiple-shots technique had no energy- related damaging effect on bone conduction hearing levels. Therefore CO2-laser stapedotomy performed according to the described technique can be considered as a safe procedure., CO2-Laser werden von vielen Ohrchirurgen im Rahmen der Behandlung der Otosklerose zur Perforation der Stapesfußplatte mit der Mehrschuß- oder der Einschusstechnik verwendet. Letzteres gelingt in etwas 68% aller Fälle. Jedoch in 78% der Revisionen mit einer verknöcherten Fußplatte sind mehrere Schüsse notwendig. Ziel der Studie war es, den Zusammenhang zwischen der verwendeten CO2-Laserenergie und der postoperativen Knochenleitungshörschwelle zu analysieren, um einen möglichen laserinduzierten Innenohrschaden zu bestimmen. Eine prospektive Analyse des Einflusses der kumulativen Laserenergie auf die postoperative Knochenleitungshörschwelle wurde mit Daten von 391 primären Fällen, die in Fälle mit 261 Einzelschuss- und 130 Fälle mit Mehrfachschuss- CO2-Laserstapedotomien (n=130) geteilt werden konnten und in Revisionsfälle, die in Operationen mit einfachem Prothesenwechsel (n=35), Perforationen einer Neomembran durch einen Einzelschuss (n=33) und multiplen Schüssen für die Perforation von reossifizierten Fußplatten (n=39) aufgeteilt werden konnten, durchgeführt. In der Langzeitbeobachtung wurden weder nach Primär- noch nach Revisionsoperationen signifikante Änderungen der Knochenleitungsschwellen in den Gruppen, bei denen eine Energie von 0, 2 J aufgewandt wurde beobachtet. In beiden untersuchten Zeiträumen (Kurzzeit: 1~3 Wochen, Langzeit: 1.5~6 Monate) wies die Mehrheit der untersuchten Patienten niedrigere postoperative Knochenleitungsschwellen auf, die sich im zeitlichen Verlauf noch verbesserten. Ein Vergleich von Studienergebnisse nach Stapedotomie, die aus der Literatur verfügbar waren zeigte, dass die von uns erhobenen Daten unter den besten waren. Schlussfolgernd beeinträchtigte während der Kurzzeitnachbeobachtungsperiode die Anwendung der Einzelschusstechnik im Rahmen der Primäroperation mit einer Energie von ≤ 1 J die Innenohrfunktion weniger als die Anwendung Mehrschusstechnik. In der Langzeitnachbeobachtungsperiode zeigte die totale verwendete CO2-Laserenergie keinen energieabhängigen schädigenden Effekt auf die Knochenleitungsschwelle unabhängig davon, ob eine Primär- oder Revisionsoperation mit der Einzelschuss- oder Mehrfachschusstechnik durchgeführt wurde. Demzufolge kann die CO2-Laserstapedotomie, mit der beschriebenen Technik, als eine für die Innenohrfunktion sichere Operation angesehen werden.

Objective The aim of this study was to evaluate stapedial decapitation technique with preservation of the stapes suprastructure for the treatment of stapedial otosclerosis. Patients and methods This study included 42 patients (17 males and 25 females) subjected to decapitation technique and 32 patients (10 males and 22 females) subjected to the usual small fenestra technique as control. Results Hearing sensitivity and air bone gap of the two groups before and five years after operations were analyzed. The mean hearing threshold level (500–4000 Hz) of preoperative versus postoperative was compared. There were no significant postoperative statistical differences in hearing threshold improvement and air bone gap closure between the two techniques used in this study all over the postoperative five years. Conclusion Stapes decapitation is an alternative technique for stapedial otosclerosis in order to refine the surgery of stapedectomy with the advantage of preservation of stapes suprastructure together with stapedial tendon. This refining in surgery is for obtaining better hearing outcome with fewer complications as well as adds simplicity in the original technique and gives another choice for the surgeon increasing the plethora of stapes surgery.

Objective: To analyze and compare the preoperative factors that potentially influence the outcome of stapedotomy in our study group. Materials and Methods: 161 cases were enrolled. Clinical variables considered to influence functional results – air conduction (AC) and bone conduction (BC) pure-tone average (PTA), air-bone gaps (ABG), sensorineural hearing loss (SNHL), ABG gain and ΔSNHL – were gender, age, case type (unilateral vs. bilateral), ear side (right vs. left), pregnancy, vascular disease and family history of otosclerosis. The audiometric variables were preoperative AC- and BC-PTA, SNHL and ABG. Results: Univariate logistic regression analysis showed that the probability of obtaining a ≥10 dB gain is significantly affected by the following factors: age 0.05). Nevertheless, multivariate logistic regression analysis maintained a statistically significant correlation only between gain ≥10 dB and both preoperative ABG ≥30 dB and age Conclusions: The accurate knowledge of predictive factors is a valuable tool that permits the surgeon to plan surgery with a better case selection as well as assisting in counseling the patient with regard to the likelihood of success of the procedure.

A proporção de pacientes com otosclerose estapediana em relação ao número de otorrinolaringologistas tem diminuído nos últimos anos. Questiona-se se a cirurgia de tratamento da otosclerose deve ou não continuar sendo ensinada para residentes. OBJETIVO: Avaliar os resultados e complicações das estapedotomias realizadas por residentes no período de janeiro de 1997 a janeiro de 2000; verificar a inclusão da estapedotomia no programa de residência médica. FORMA DE ESTUDO: Estudo de coorte histórica longitudinal. MATERIAIS E MÉTODOS: Avaliados 50 prontuários de pacientes submetidos a um total de 51 estapedotomias quanto às complicações e resultados audiológicos. RESULTADOS: Fechamento do gap aéreo-ósseo para menor ou igual a 10dB NA em 70,5% das orelhas e menor ou igual a 20 dB NA em 86,3% das orelhas. Ocorreu 1 caso de surdez total. Complicações: subluxação da bigorna (7,8%), perfuração da membrana timpânica (5,8%), vertigem incapacitante que se resolveu dentro de 3 semanas (5,8%), otorréia (3,9%), platina flutuante (1,95) e fístula perilinfática (1,9%). CONCLUSÃO: A análise da literatura e os resultados e complicações obtidos neste estudo permitem concluir que a estapedotomia pode ser incluída no programa de residência médica, desde que haja disponibilidade de casos cirúrgicos para o treinamento dos residentes. The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM: the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS: fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS: there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). CONCLUSION: From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Summary The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. Aim: the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. Study design: retrospective review of prospectively collected audiometric data. Materials and methods: fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. Results: there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). Conclusion: From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Objective: Comparing hearing results in patients with otosclerosis treated with laser-assisted stapedotomy using the 2-μm thulium laser or the CO2 laser. Study design: Prospective nonrandomized clinical study. Setting: In a tertiary referral center in France (Jean Causse Ear Clinic, Béziers), 208 primary stapedotomies were performed in 204 patients between March 2008 and November 2009. Sufficient follow-up data were available for 194 procedures. Methods: The fenestration in the footplate was made with the thulium laser in 98 procedures and with a flexible CO2 laser in 96 procedures. Preoperative and postoperative audiometric results were compared. Side effects, such as vertigo and tinnitus, were scored. Results: Patients treated with the CO2 laser had better hearing outcome compared with those treated with the thulium laser at both 3 and 12 months of follow-up. At 3 months, the success of the surgery, defined as closure of the air-bone gap to within 10 dB, was 90.0% in the thulium group compared with 96.8%in the CO2 group. Bone conduction shift showed an overall deterioration of 1.6 dB (standard deviation, 6.9 dB) in the thulium group compared with an improvement of 1.3 dB (standard deviation, 4 dB) in the CO2 group. In the thulium group, there were four patients with sensorineural hearing loss (4.4%) and three with tinnitus (3.1%) compared with none in the CO2 group. Conclusion: Stapedotomy surgery performed with a fiber-delivered thulium laser resulted in a higher chance of inner ear damage measured by bone conduction shift compared with the use of a fiber-delivered CO2 laser. We advise not to use the thulium laser for stapedotomy.

Introdução: Otospongiose ou otosclerose é uma moléstia heredo-degenerativa da cápsula labiríntica relativamente comum e que ocorre principalmente em mulheres entre 20 e 30 anos de idade. Nas últimas décadas a estapedotomia tem sido uma técnica preferida por muitos cirurgiões para o tratamento da otosclerose. Assim, esse trabalho analisa os resultados de 59 estapedotomias realizadas no Hospital Paulista de Otorrinolaringologia nos últimos 7 anos. Forma de estudo: Clínico randomizado. Materiais e Métodos: Estudo retrospectivo de 59 pacientes com otosclerose, submetidos a estapedotomia por um mesmo cirurgião, e com seguimento clínico e audiométrico. Resultados: Melhora auditiva comprovada pelo fechamento do gap na audiometria em 53 pacientes (90%). Complicações ocorridas são relacionadas por ordem decrescente de freqüência: deslocamento da prótese (7%), alterações no paladar (7%), paralisia facial (3%), vertigem (3%), extrusão total da prótese (1,5%), tinnitus persistente (1,5%), perfuração da membrana timpânica (1,5%). Conclusão: A estapedotomia vem se mostrando uma boa opção terapêutica, já que, em geral, apresenta baixa morbidade e altas taxas de sucesso, proporcionando melhor qualidade de vida para os portadores de otosclerose. Introduction: Otospongiosis or otosclerosis is a common degenerative and hereditary disease of the labyrinthine capsule and occurs mainly in women with age between 20 and 30 years. In recent decades stapedotomy has increasingly tended to become the most used surgical technique to the treatment of otosclerosis. Thus, this study analyzes the results of 59 stapedotomies realized in Paulista Hospital of Otorhinolaryngology on the last 7 years. Study design: Clinical randomized. Materials and Method: Retrospective analysis of 59 patients with otosclerosis who underwent stapedotomy performed by the same surgeon and follow-up clinical and audiological. Results: Hearing improvement proved by audiogram air-bone gap closure in 53 patients (90%). The complications occurred were displaced prosthesis (7%); taste alterations (7%); facial paralysis (3%); vertigo (3%); prosthesis total extrusion (1,5%); tinnitus (1,5%); tympanic membrane perforation (1,5%). Conclusion: Stapedotomy has been seen as good therapeutic choice to the treatment to the conductive hearing loss by otosclerosis seeing that generally has low morbidity and high success rates, providing better life quality to this patients.

Developments in surgical technique and, more importantly, the use of increasingly sophisticated biocompatible prostheses have meant that good results can be achieved for otosclerosis sufferers in terms of restored hearing and very little postsurgical discomfort. We set out to assess whether the diameter of the prostheses used for stapedotomy (platinum piston/polytetrafluoroethylene, i.e. Teflon) has any effect on surgical outcome. Two groups of otosclerotic patients were selected, and these underwent stapedotomy surgery during the second phase of the disease. A piston-Teflon type prosthesis was used, 5.50 mm in terms of length but of different diameters (group A: 0.4 mm; group B: 0.6 mm). All the patients underwent the same pure-tone audiometry test before surgery, and then at 1 week and 1 month after surgery, to assess function. We compared air conduction after surgery with bone conduction before surgery. The data collected was analysed using the χ2 (p < 0.05) test. This analysis showed that the results obtained with a 0.4-mm prosthesis or a 0.6-mm prosthesis are almost identical. There was no statistically significant difference in terms of hearing results when comparing either average tonal threshold or when analysing audiometric data frequency by frequency. It can be concluded, therefore, that in stapedotomy surgery, functional recovery is not affected by the diameter of the prosthesis used. A smaller diameter prosthesis is, however, the one of choice when the facial nerve is prominent or the oval window particularly narrow.

Summary Objectives The aim of this study was to identify the causes and the audiometric results of revision surgery following stapedotomies and stapedectomies. Patients and methods We retrospectively reviewed a series of 89 revisions after surgery for otosclerosis between 1993 and 2008. Intraoperative findings, causes of failure, and pre- and postoperative audiometric results were noted retrospectively. Results The leading causes of failure found intraoperatively included dislocated prosthesis and necrosis of the long process of the incus. The average postoperative air–bone gap was 13 dB. Closure of the air–bone gap to within 10 dB was achieved in 52% of patients. Conclusion Stapes revisions had less satisfactory results compared with primary procedures in this series. However, certain precautions during initial surgery should decrease the number of stapes surgery revisions.

In our experience some patients subjected to stapedotomy presented vestibular symptoms characterized by brief episodes of vertigo that only lasted 10 to 20 seconds, accompanied by rapid paroxysmal nystagmus similar to that found in benign paroxysmal positional vertigo (BPPV). For this study, 141 otosclerotic patients were enroled and underwent stapedotomy following the Fisch and Dillier's technique. Twelve out (8.5%) of all the patients under study complained of post-operative vertigo and the physical examination of the positional nystagmus confirmed the presence of paroxymal positional vertigo. The percentage seems particularly high and does not agree with the data reported in literature. The onset of the vestibular symptoms appeared between the 5th and 21st day after surgery. To our knowledge, this is the first prospective study existing in literature on the incidence of BPPV after surgery of the stapes. It must also be stressed that the patient should be informed beforehand during the consultation phase of the possibility of post-stapedotomy BPPV together with the other causes of post-operative vertigo.