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A persistent stapedial artery is a congenital vascular malformation that can cause tinnitus and/or conductive hearing loss. Although rare, this case highlights the importance of recognizing aberrant anatomy as a potential cause of patients' symptoms. It also demonstrates how to recognize and treat patients with a symptomatic persistent stapedial artery. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is a disease of the osseous labyrinth. The disease causes 5% to 9% of all cases of hearing loss and 18% to 22% of conductive hearing loss. The treatment of choice is a surgery. The hearing improvement after the operation is determined by various factors. Aims/Objectives: The aim of the analysis is to determinate changes in hearing after stapedoplasty in view of surgery side in the patients operated on otosclerosis by right-handed surgeons. Material and Methods: The analysis involved patients hospitalized and operated on otosclerosis between 2012 and 2018. Only patients with their first middle ear surgery due to otosclerosis were included in the study. The patients were operated by 2 right-handed surgeons who used the same surgical technique and had similar experience in otosclerosis surgery. The study included patients who were divided into 2 groups: with self-tightening prosthesis and with manually tightening prosthesis. Results: The procedure performed by right-handed operators on the left side using prostheses requiring manual fixation on the incus was associated with poorer audiometric results compared to the results of surgeries on the right side. In patients with the self-tightening prostheses, the audiometric improvement of hearing was bilaterally comparable independently from operation side. Conclusion: (1) The dependence of hearing improvement on the surgery side was demonstrated in cases of surgeries performed on the left ear by right-handed surgeons, particularly with manually tightening prosthesis. (2) Self-tightening prostheses in stapedotomy limit the human factor, reducing the risk of complications after otosclerosis surgery and provide repeatable hearing improvement. [ABSTRACT FROM AUTHOR]

The study is aimed to assess the scope of endoscopic stapedotomy in overcoming technical challenges faced during conventional stapedotomy using operating microscope. Sixty-four patients with clinical and audiological diagnosis of otosclerosis were randomly assigned into one of the 2 groups—one underwent conventional stapedotomy using operating microscope, while the other group underwent endoscopic stapedotomy, the operating surgeon being the same for both groups, for all cases. The 2 groups were observed in terms of extent of the postero-superior canal bone curettage/drilling, chorda tympani repositioning, visualization of footplate area, surgical time from first incision to ear packing, post-operative morbidity in terms of post-operative pain, vertigo, hearing outcome, and changes in taste sensation. It was observed that irrespective of the width of the external auditory canal, endoscopic approach offered better access to the footplate area requiring lesser bone removal and chorda tympani repositioning. The operating time, post-operative pain, and changes in taste sensation were significantly less in the endoscopic group. However, no difference was noted in terms of the post-operative hearing outcome and incidence of vertigo. Endoscopic stapedotomy has clear advantages in terms of the technicality and accessibility to the working area as well as faster recovery. [ABSTRACT FROM AUTHOR]

Objective:The results of a recently published micro-CT study suggested a correlation of the distance between long incus process and stapes footplate and the required prosthesis length in malleostapedotomy. The goal of this study was to test the reliability of that assumption.Methods:Rectangular and bent prostheses were tested in 11 cadaveric human temporal bone specimens; 1 of them showed a stapedial artery. Prosthesis length was calculated based on the distance between long incus process and stapes footplate. The rate of acceptable prosthesis insertion into the vestibule was investigated.Results:In both prostheses designs, the insertion depth into the vestibule did not exceed 1.0 mm. Two prostheses did not pass the footplate level in bent prostheses (18%) and 1 in rectangular prostheses (9%).Conclusion:A rough estimation of the required prosthesis length in malleostapedotomy seems possible if the distance between long incus process and stapes footplate is known and a design-dependent equation exists. [ABSTRACT FROM AUTHOR]

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a "reverse 7" shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis. [ABSTRACT FROM AUTHOR]

The middle ear muscle (MEM) reflex is one of two major descending systems to the auditory periphery. There are two middle ear muscles (MEMs): the stapedius and the tensor tympani. In man, the stapedius contracts in response to intense low frequency acoustic stimuli, exerting forces perpendicular to the stapes superstructure, increasing middle ear impedance and attenuating the intensity of sound energy reaching the inner ear (cochlea). The tensor tympani is believed to contract in response to self-generated noise (chewing, swallowing) and nonauditory stimuli. The MEM reflex pathways begin with sound presented to the ear. Transduction of sound occurs in the cochlea, resulting in an action potential that is transmitted along the auditory nerve to the cochlear nucleus in the brainstem (the first relay station for all ascending sound information originating in the ear). Unknown interneurons in the ventral cochlear nucleus project either directly or indirectly to MEM motoneurons located elsewhere in the brainstem. Motoneurons provide efferent innervation to the MEMs. Although the ascending and descending limbs of these reflex pathways have been well characterized, the identity of the reflex interneurons is not known, as are the source of modulatory inputs to these pathways. The aim of this article is to (a) provide an overview of MEM reflex anatomy and physiology, (b) present new data on MEM reflex anatomy and physiology from our laboratory and others, and (c) describe the clinical implications of our research. [ABSTRACT FROM PUBLISHER]

Today cochlear implantation is a widely used means of treatment in deafness and severe hearing disorders in adults, children, and infants. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. However, especially in infants and young children, this fitting process can be difficult because of limited communication capabilities. The use of intraoperatively obtained stapedius reflex thresholds has been proposed for postoperative speech processor fitting, but the influence of anesthetics on threshold values needs to be taken into account. In a retrospective study with 20 patients between 3 and 43 years of age, a highly significant correlation between the dosage of methohexital and the mean stapedius reflex threshold value could be shown (r = 0.65, p = .002). We conclude that more reliable threshold values can be obtained by reducing the dosage of hypnotics to achieve a lighter level of hypnosis during stapedius reflex measurement. To achieve a light, but still sufficient level of hypnosis, electroencephalographic monitoring including automatic interpretation of the complex raw signal should be used. [ABSTRACT FROM AUTHOR]

Cochlear implants have recently begun to be offered to patients with single-sided deafness (SSD). Implantation in these patients has led to good results in suppressing ipsilateral tinnitus and in providing audiologic benefits in terms of speech perception in noise and localization. One previously unreported benefit of cochlear implantation in patients with SSD is the restoration of functional hearing in the previously deaf ear, which may allow for surgical opportunities in the contralateral hearing ear. We report a case in which cochlear implantation in the deaf left ear of a 50-year-old man allowed for surgical intervention in the previously only-hearing right ear, which in turn led to the restoration of normal middle ear function. Further studies may be warranted to consider the surgical candidacy of the contralateral only-hearing ear as another potential indication for cochlear implantation in patients with SSD. [ABSTRACT FROM AUTHOR]

Myoclonus of the middle ear is a very rare condition. We present the case of a 20-year-old soldier who was exposed to intense artillery noise during a fierce battle and immediately afterward complained of an incapacitating tinnitus in both ears. Microscopic examination of the ears demonstrated rapid rhythmic movements of the tympanic membrane coinciding with the tinnitus, which was also easily heard by the examiner. There was no evidence of palatal myoclonus, and thus the diagnosis of middle ear myoclonus was made. Exploratory tympanotomy confirmed the diagnosis of stapedial muscle myoclonus. Bilateral sectioning of the stapedial tendons brought immediate relief of the tinnitus to the patient. We review the literature of middle ear myoclonus and discuss the symptoms, evaluation, and management of this rare condition. [ABSTRACT FROM AUTHOR]

The article presents the case of a 46-year-old male who was rushed to the Otolaryngology Department due to right-sided hearing loss for 10 years. Based on audiogram, he has right maximal conductive loss and a Carhart notch. He was eventually diagnosed with persistent stapedial artery (PSA) with ankylosis of the stapes footplate. He opted to use hearing aids to resolve his conductive hearing loss.