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Objectives: Piezosurgery (Mectron Medical Technology, Genoa, Italy) is a new ultrasound instrument (24.7-29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissues damage. The aim of this work has been to report our experience with the piezoelectric device in otologic surgery., Study Design: We have used the piezoelectric device in 50 patients affected by otosclerosis, 50 by chronic otitis media, 20 by posttraumatic facial nerve palsy, 10 by type A glomus tympanicum tumor, and in three patients with a B-cell non-Hodgkin lymphoma., Subjects and Methods: Patients underwent platinotomy, mastoidectomy, antroatticotomy, posterior tympanotomy, facial nerve decompression, and excision of middle ear tumors. Before and 6 months after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording., Results: In each surgical technique, the piezoelectric device provided excellent control without side effects on the adjacent structures of the middle and inner ear., Conclusions: The piezoelectric device is a new and revolutionary bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue will not be damaged even on accidental contact with the cutting tip; this renders the piezoelectric device ideal for otologic bone surgery.

Objectives: Compare short-term hearing outcomes with a heat-activated-crimping versus manual-crimping stapedectomy prosthesis., Study Design: Retrospective chart review., Setting: Tertiary care neurotology referral center., Patients: 219 charts reviewed., Intervention: Laser stapedectomy., Main Outcome Measures: Audiometric., Methods: Retrospective study comparing postoperative hearing in manual-crimp prostheses stapedectomies versus heat-activated-crimp prostheses stapedectomies., Results: Of the 219 patients reviewed, 94 met inclusion criteria for the study, with 47 receiving manual-crimp prosthesis and 47 receiving heat-activated-crimp prosthesis. Short-term poststapedectomy air-bone gaps, long-term air-bone gaps, long-term pure-tone averages, and long-term air-bone gap closures were significantly better for heat-activated-crimp versus manual-crimp prostheses., Conclusion: Heat-activated-crimping prostheses demonstrated enhanced stapedectomy hearing outcomes versus manual-crimping prostheses on short- and long-term follow-up. Three-dimensional reorientation of the heat-activated prosthesis may enhance the hearing outcome; however, theoretical nickel allergy considerations, effects of case selection, follow-up duration, possible eventual loosening of the heat-activated crimp, and long-term incus necrosis are considerations requiring continued longitudinal analysis.

Objective: To further optimize the surgical technique with the CO 2 laser in stapes surgery a scanner system was used to obtain a footplate perforation of 0.5 to 0.6 mm with only 1 laser application ("one-shot" stapedotomy)., Study Design: 188 patients with otosclerosis were submitted to a primary CO 2 laser stapedotomy with the SurgiTouch scanner. This study surveys the surgical technique and clinical results., Results: An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated with the SurgiTouch scanner. In 11% of the patients, a second laser application at the same site was necessary. In 21% of the patients, the perforation had to be enlarged by several slightly overlapping laser applications without scanner. The clinical data of this study clearly documents that there is no evidence of laser depending inner ear affections., Conclusion: The CO 2 laser combined with modern scanner systems is well suited for application in stapes surgery.

Objective: Micropick fenestration of the stapes footplate, a difficult step in stapedotomy, was selected for trials evaluating the potential for robotic assistance (RA) to improve clinical measures of surgical performance., Study Design: In a surgical model of stapedotomy, we measured accuracy of fenestration to a desired point location and force applied to the stapes footplate. Performance variables were measured for 3 experienced and 3 less-experienced surgeons., Results: RA significantly reduced the maximum force applied to the stapes footplate. For fenestration targeting, RA significantly improved accuracy for less-experienced surgeons and significantly worsened targeting for more-experienced surgeons., Conclusions: RA significantly improves performance for micropick fenestration in a surgical model of stapedotomy. For certain tasks, RA differentially affects performance for users of different experience levels., Clinical Significance: These are the first results showing quantitative improvements in performance during simulated ear surgery using RA and differential effects of RA on performance for users of different experience levels.

Objective: To evaluate results of revision stapedectomy with and without use of the laser and determine factors predictive of hearing outcome., Study Design and Setting: Retrospective review of 356 revision stapedectomy operations performed at the House Ear Clinic, a tertiary neurotologic private practice, between 1983 and 1995., Results: A postoperative gap of < or =10 dB was obtained in 60% of cases. Results were similar with and without the use of a laser. Sensorineural hearing loss of >10 dB occurred in 7.7%, with 3 (1.4%) ears with profound hearing loss. A poorer outcome was related to incus necrosis, multiple revisions, and indications for surgery other than conductive hearing loss., Conclusion: Revision stapedectomy can provide good gap closure in 60% of cases, with small risk of sensorineural hearing loss., Significance: Although not as satisfactory as primary stapedectomy, revision stapedectomy can be offered to patients with reasonable expectations for good gap closure.

Primary stapedectomies were performed on 60 patients with bilateral otosclerosis. Every patient had a 4 mm long Robinson prosthesis with a 0.4 mm wide shaft placed in one ear and a 4 mm long Robinson prosthesis with 0.6 mm wide shaft placed in the opposite ear. With the 0.4 mm wide prosthesis, 54 patients overclosed the air bone gap and 6 were within 10 dB of closing. With the 0.6 mm wide prosthesis, which was placed in the opposite ear, 51 patients overclosed their air-bone gap and 8 were within 10 dB of closing. We conclude that there is no statistical difference in hearing results between the 0.4 mm and the 0.6 mm wide Robinson prosthesis when they are used in a partial stapedectomy with a vein graft covering the oval window.

In summary, we believe that the endo-otoprobe system offers several advantages to the otologist. The system is safe and relatively inexpensive. The probes are designed to provide tactile feedback similar to that of standard otologic instruments and avoid the use of a cumbersome micromanipulator. There are currently shapes that are similar to a Rosen needle, Shea pick, and bayonet. We hope most otologists will find that one of the endo-otoprobes fits their particular style of surgery.

This study analyzes 71 stapedectomies that resulted in a sensorineural hearing loss, followed by a revision stapedectomy on the suspicion of an oval window fistula. The cases were divided between two primary stapedectomy techniques: a stainless steel Robinson prosthesis on a vein graft and a wire prosthesis with Gelfoam. The major differences between the surgical findings of the two groups were the fistula rate with the wire prosthesis was 10 times that with the Robinson prosthesis; the wire prosthesis was longer than necessary in 21% of the cases in which it was used; there was no finding of excess length with the Robinson prosthesis; and after revision stapedectomy, dizziness was lessened in 20% of the patients in the Robinson prosthesis group, in 60% of those in the wire prosthesis group, and in 75% of those with fistula. Surgical directions are given for revision stapedectomy following a sensorineural hearing loss.

With the four-sided point of the C-wire hand drill there is less risk of footplate mobilization during small fenestra stapedectomy. The small fenestra stapedectomy is thought to cause less trauma to the vestibule and to pose less risk of aspirating vestibular contents than the stapedectomy that totally removes the footplate.