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Objective: To summarize current knowledge on the indications, surgical strategies, and auditory outcomes of revision stapes surgery (RSS) for otosclerosis. Data Sources: The search was conducted in PubMed, Scopus, and Web of Science online databases, including papers published since 2000. Review Methods: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. We considered original series describing RSS for otosclerosis, reporting postoperative hearing outcomes according to the American Academy of Otolaryngology–Head and Neck Surgery guidelines for conductive hearing loss (CHL) for at least 30 consecutive cases. The quality of included studies was assessed with the Joanna Briggs Institute checklist. Pooled proportion and odds ratio (OR) meta‐analysis were conducted using random effect models. Results: Nineteen studies were included, for a total of 2602 patients (2735 ears) and 2359 postoperative hearing results. RSS was mostly performed for recurrent CHL with air‐bone gap (ABG)>20 dB. Multiple concomitant causes were often present, with prosthesis placement defect and incus necrosis as the most common causes. The pooled proportion of postoperative ABG<10 dB and ABG<20 dB was 57.2% (95% confidence interval [CI]: 52.8%‐61.4%) and 79% (95% CI: 76.0%‐81.8%), respectively. Dead ears were 1.2% (95% CI: 0.7%‐2.1%). Compared to primary surgery, RSS had a significantly lower rate of ABG<10 dB (OR = 0.36, 95% CI: 0.24%‐0.54%; P <.001). Both revision incudostapedotomy with/without incus reconstruction and malleovestibulopexy are viable options with nonsignificant differences in ABG closure rates (P =.182). Conclusion: RSS is challenging and requires the surgeon to carefully evaluate all potential causes of previous failure and tailor the intervention according to intraoperative findings. In most cases, ABG closure within 20 dB can be achieved with a relatively low risk of dead ears. [ABSTRACT FROM AUTHOR]

Objective: Placing a middle ear prosthesis is considered a key competency for the general otolaryngologist, but surgeons struggle to obtain and maintain this skill. The current study aims to characterize pre‐coronavirus disease 2019 trends in stapedectomy and ossiculoplasty. Study Design: Database review. Setting: Tricare beneficiaries are treated at civilian and military facilities. Methods: The Department of Defense beneficiary population of more than nine million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty between 2010 and 2019, identified by the current procedural terminology code. Results: A total of 3052 stapedectomies and 7197 ossiculoplasties were performed. Over the 10‐year study period, stapedectomy decreased by 23%, with an average annual rate of −2.7% per year (Pearson r = −.91, P =.0003). Ossiculoplasties declined by 18%, an average annual rate of −1.9% (r = −.8, P =.006). In combination, cases declined by 20%, an average annual rate of −2.2% (r = −.87, P =.001). Conclusion: While declines in stapedectomy surgery have been well reported, here we show steady declines in ossiculoplasty as well. If these trends continue, more cochlear implantations may be performed annually than stapedectomy and ossiculoplasty combined, with cochlear implantation likely to overtake ossicular chain surgery in the near future. These changes in surgical volume have a direct implication on resident education and general otolaryngology expectations after graduation. Strong consideration should be made to replace "Stapedectomy/Ossiculoplasty" as resident key indicator with "Cochlear Implantation," a more professionally meaningful skill. [ABSTRACT FROM AUTHOR]

Objective: Sensorineural hearing loss is a known complication of stapes surgery. We previously showed that laser stapedotomy can result in intracochlear pressures that are comparable to high sound pressure levels. Optimizing laser settings to those that correspond with the lowest pressure changes may mitigate risk for postoperative hearing loss. Here we quantify the effects of various laser parameters on intracochlear pressures and test the hypothesis that intracochlear pressure changes are proportional to the laser energy delivered. Study Design: Basic and translational science. Setting: Cadaveric dissection and basic science laboratory. Methods: Cadaveric human heads underwent mastoidectomies. Intracochlear pressures were measured via fiber‐optic pressure probes placed in scala vestibuli and tympani. Pulses of varied stimulus power and duration from a 980‐nm diode laser were applied to the stapes footplate. Results: Sustained high‐intensity pressures were observed in the cochlea during all laser applications. Observed pressure magnitudes increased monotonically with laser energy and rose linearly for lower stimulus durations and powers, but there was increased variability for laser applications of longer duration (200‐300 ms) and/or higher power (8 W). Conclusions: Results confirm that significant pressure changes occur during laser stapedotomy, which we hypothesize may cause injury. Overall energy delivered depends predictably on duration and power, but surgeons should use caution at the highest stimulus levels and longest pulse durations due to the increasing variability in intracochlear pressure under these stimulus conditions. While the risk to hearing from increased intracochlear pressures from laser stapedotomy remains unclear, these results affirm the need to optimize laser settings to avoid unintended injury. [ABSTRACT FROM AUTHOR]

Objectives: To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. Study Design: Retrospective cohort study. Setting: Large single-institution database. Methods: Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. Results: Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P <.001), as were those to ≤20 dB (78.1% vs 90.9%, P <.001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P =.016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P <.001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P =.010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P <.001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P =.001) and hydrops (1.8% vs 0.2%, P =.008) were higher in revision cases. Conclusions: Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. Level of Evidence: 4 (retrospective observational research). [ABSTRACT FROM AUTHOR]

Objective: To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources: PubMed, Embase, and Web of Science. Review Methods: An electronic search was conducted with the keywords "endoscop* or microscop*" and "stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation." Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results: The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions: Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery. [ABSTRACT FROM AUTHOR]

Background: Surgical management of otosclerosis is technically challenging with studies demonstrating that outcomes are commensurate with surgical experience. Moreover, experts apply less force on the ossicular chain during prosthesis placement than their novice counterparts. Given the predicted decreasing patient pool and the rising cost of human temporal bone specimens it has become more challenging for trainees to receive adequate intraoperative or laboratory‐based experience in this procedure. As such, there is a need for a low‐cost training model for the procedure. Here we describe such a model. Methods: A surgical model of the middle ear was designed using computer aided design (CAD) software. The model consists of four components, the superior three dimensional (3D)‐printed component representing the external auditory canal, a 90° torsion spring representing the incus, a 3D‐printed base with a stapedotomy underlying the torsion spring, and a 3D‐printed phone holder to facilitate video‐recording of trials and subsequent calculation of the force applied on the modeled incus. Force applied on the incus is calculated based on Hooke's Law from post‐trial computer‐vision analysis of recorded video following experimental determination of the spring constant of the modeled incus. Results: The described model was manufactured with a total cost of $56.50. The spring constant was experimentally determined to be 97.0 mN mm/deg, resulting in an ability to detect force applied to the modeled incus across a range of 1.2 to 5200 mN. Conclusions: We have created a low‐cost middle‐ear training model with measurable objective performance outcomes. The range of detectable force exceeds expected values for the task. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter.Methods: We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis.Results: Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89).Conclusions: Endoscopic stapes surgery is a valid alternative to the microscope.Level Of Evidence: 2a Laryngoscope, 130: 2019-2027, 2020. [ABSTRACT FROM AUTHOR]

Objective: The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy.Study Design: Retrospective observational study of national health care claims.Setting: 2003 to 2016 Optum Clinformatics Data Mart.Subjects and Methods: In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery.Results: The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; t test, P < .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; t test, P < .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; t test, P < .0001). A higher number of children was correlated with lower age for both females (Pearson, r = -0.3817, P < .0001) and males (Pearson, r = -0. 3675, P < .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children (F(3, 6021) = 336.93, P < .001, R2 = 0.1437) with no significant interaction between sex and number of children (P = .186).Conclusion: Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis. [ABSTRACT FROM AUTHOR]

Intratympanic (IT) steroid therapy is a mainstay treatment for sudden sensorineural hearing loss (SSNHL) for both initial therapy and salvage therapy. We report a rare case of iatrogenic perilymphatic fistula that resulted from trauma during an IT steroid injection for SSNHL. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature. Laryngoscope, 131:2088–2090, 2021 [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to provide a proof of concept and to assess the success and safety of stapes surgery for otosclerosis under local anesthesia in an office-based setting (OBS) as compared with a hospital operating room setting (ORS).Study Design: Retrospective cohort study.Setting: We reviewed all patients who underwent stapes surgery by the same surgeon from October 2014 to January 2017 at our tertiary care center (ORS, n = 36, 52%) and in an OBS (n = 33, 48%).Subjects and Methods: The surgical technique was identical in both groups. All patients had a temporal bone computed tomography scan and audiogram within the 6 months prior to surgery. Air-bone gaps (ABGs), bone conduction, and air conduction pure tone average values were calculated. Preoperative results for pure tone average, bone conduction, ABG, and word recognition scores were compared with early (4 months) and late (12 months) follow-up audiograms. Intra- and postoperative complications were compared.Results: Both groups were comparable in terms of demographic characteristics and severity of disease. The mean 1-year postoperative ABG was 5.66 dB (95% CI = 4.42-6.90) in the ORS group and 6.30 dB (95% CI = 4.50-8.10) in the OBS group (P = .55). ABG improved by 24.27 dB (95% CI = 21.40-27.13) in the ORS group and 23.15 dB (95% CI = 18.45-27.85) in the OBS group (P = .68). Complication rates did not differ, although this study remains underpowered.Conclusions: In this small group of patients, the success of stapes surgery performed in an OBS and its complications were comparable to those of an ORS, thus providing an alternative to patients on long operating room waiting lists. [ABSTRACT FROM AUTHOR]

Objective: To identify costs and operative times for stapedotomy and evaluate factors influencing cost variation.Study Design: Case series with cost analysis.Setting: Multihospital network.Subjects and Methods: A multihospital network's standardized activity-based accounting system was used to determine costs and operative times of all patients undergoing stapedotomy from 2013 to 2017. Subjects with additional procedures were excluded. Correlations between variable factors and cost were calculated by Spearman correlation coefficients. Audiometric and cost data were compared with a Mann-Whitney U test.Results: The study cohort included 176 stapedotomies performed by 23 surgeons at 10 hospitals. Mean ± SD patient age was 44.3 ± 17.4 years. Mean cut-to-close time was 61.1 ± 23.55 minutes. Mean total encounter cost was $3542.14 ± $1258.78 (US dollars). Significant factors correlating with increased total encounter cost were surgical supply cost (r = 0.74, P < .0001) and cut-to-close time (r = 0.66, P < .0001). Laser utilization ($563.37 ± $407.41) was the highest-cost surgical supply, with the carbon dioxide laser being significantly more costly than the potassium titanyl phosphate (KTP; $852.60 vs $230.55, P < .001). Additionally, the carbon dioxide laser was associated with a significantly higher mean total encounter cost than the KTP laser ($4645.43 vs $2903.00, P < .001) and cases where no laser was used ($4645.43 vs $2932.47, P < .001). There was no difference in mean total encounter cost between the KTP laser and cases of no laser use ($2903.00 vs $2932.47, P = .75).Conclusions: Significant cost variation exists in stapes surgery. Surgical supply cost, specifically laser use, may be associated with significantly increased costs. Reducing variation in costs while maintaining outcomes may improve health care value. [ABSTRACT FROM AUTHOR]

A study of clinical records and temporal bone histopathology from a woman with bilateral otosclerosis who was treated with lateral semicircular canal fenestration procedures as well as stapedectomy. [ABSTRACT FROM AUTHOR]

Objective: To compare endoscopic and microscopic pediatric stapes surgery.Study Design: Case series with chart review.Setting: Two academic otology practices.Subjects and Methods: Surgical and hearing outcomes were compared for consecutive children (<18 years) undergoing microscopic and endoscopic stapes surgery. The main outcome measure was closure of the air-bone gap (ABG) to ≤20 dB.Results: Twenty-two endoscopic surgeries (17 stapedectomies, 4 stapedotomies, and 1 stapes mobilization) and 52 microscopic surgeries (30 stapedectomies, 19 stapedotomies, and 3 stapes mobilizations) were performed. Patient demographics, history of ipsilateral middle ear surgery, and revision stapes surgery status were similar. The most common diagnosis for the endoscopic group and microscopic group were congenital stapes footplate fixation (45.5%) and juvenile otosclerosis (46.2%), respectively. Preoperative ABGs in the endoscopic (37.7 dB) and microscopic (32.8 dB) groups (P = .170) were similar. There were no major complications, including facial nerve injury or anacusis, in the endoscopic group. Postoperative sensorineural hearing loss (>15 dB) did not occur in any patients in the endoscopic group but was present in 2 patients in the microscopic group (P = .546). Improvement in pure-tone average (25.9 dB vs 18.5 dB, P = .382) and ABG (21.7 dB vs 14.7 dB, P = .181) was similar, and postoperatively, the median ABG was 11.3 dB and 15.0 dB for endoscopic and microscopic cases (P = .703), respectively. ABG closure to ≤20 dB (72.7% vs 65.2%, P = .591) was also similar.Conclusion: Pediatric endoscopic stapes surgery is safe and hearing outcomes are similar to the microscopic approach when performed by experienced endoscopic ear surgeons. [ABSTRACT FROM AUTHOR]

The article offers information on the study that aims to analysis the results of stapes superstructure and incudostapedial joint preservation in otosclerosis surgery. It discussed the information on Otosclerosis is characterised by abnormal spongy bone growth of the otic capsule that cause a predominantly conductive hearing loss and mentions the report on an average hearing gain of 26 dB while using the technique.

Congenital stapes fixation is characterized by congenital conductive hearing loss that is not progressive. This rare disease may be accompanied by additional middle ear anomalies. However, the occurrence of congenital stapes fixation with cleft palate and oligodontia was described by Gorlin et al. in 1973, and no further cases have been reported in the literature. Congenital stapes fixation was detected after the exploratory tympanotomy operation performed on a 15‐year‐old male patient admitted to our clinic with hearing loss, more prominent on the left. The patient also had a previous operation due to cleft lip and had congenital deficiencies in the upper and lower teeth. We present the second case report in the literature which we think belongs to this syndrome, which is defined as cleft palate, stapes fixation, and oligodontia syndrome by Gorlin et al. Laryngoscope, 131:E1279–E1281, 2021 [ABSTRACT FROM AUTHOR]

Stapedectomy remains a joint key-indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age- and sex-standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents' case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of "stapedectomy" from the list of 14 key-indicator case requirements, leaving ossiculoplasty as its own key-indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist. [ABSTRACT FROM AUTHOR]

Objectives: First, to determine if prosthesis length plays a role in optimizing successful hearing outcomes in stapedotomy surgery; and second, to determine if patient factors such as height are correlated with prosthesis length.Study Design: Retrospective chart review.Methods: Retrospective chart review of patients undergoing stapedotomy surgeries with adequate follow up. Length of prosthesis, pre-/postoperative audiograms, and follow-up data were obtained.Results: The primary group consisted of 227 cases. The prosthesis length ranged from 3.75 mm to 4.75 mm (median 4.25 mm). The greatest improvement in postoperative air-bone gap (ABG) occurred in the 4.25 mm group, and the least in the 3.75 mm group. Patient height showed a positive, although weak, correlation with prosthesis length. No findings reached statistical significance.Conclusion: Accurate measurement of prosthesis length is important for successful postoperative hearing outcomes. There is a positive but not significant correlation between patient height and prosthesis length.Level Of Evidence: 4. Laryngoscope, 128:722-726, 2018. [ABSTRACT FROM AUTHOR]

The article discusses the approach of the researcher to revision stapes surgery and the outcomes from 49 procedures at a UK tertiary center. Revision stapes surgery are perceived to be difficult. Cases may harbor factors which include failure of primary surgery and including advanced otosclerotic disease and additional pathology such as lateral ossicular chain fixation, or difficult access due to anatomy.

Objectives: To investigate intra- and postoperative outcomes of endoscopic stapes surgery.Study Design: Case series with chart review.Setting: Four tertiary care otologic centers.Subjects and Methods: Sixty-five subjects 18 years and older who underwent endoscopic stapes surgeries were analyzed. Variables analyzed included surgical techniques and intraoperative findings. Outcomes measured included postoperative hearing and complications to date.Results: Fifty-one patients met inclusion and exclusion criteria. The average patient age was 48.1 years (range, 26-87 years), with 60.0% female patients. Patients had a median follow-up of 5.13 months (range, 0.8-57.4 months). Of the subjects, 71.7% required scutum removal. The chorda tympani nerve was manipulated in 94.0% of subjects and transected in 12.0%. At last follow-up visit, the median air-bone gap decreased from 34.5 dB hearing level (HL) preoperatively to 9.0 dB HL postoperatively (P < .0001). Ninety percent of subjects had closure of their air-bone gap ≤20 dB HL. Intraoperative complications included tympanic membrane tears in 8.0% of subjects, all of which resolved at first follow-up. Postoperatively, 10.0% of subjects complained of altered taste.Conclusions: The present multicentered study of endoscopic stapes surgery demonstrates similar audiometric and postoperative outcomes previously published in the literature, with a median postoperative air-bone gap of 9.0 dB HL. Future prospective endoscopic stapes surgery studies, addressing the need for scutum removal, postoperative taste changes, and pain scores, are merited. [ABSTRACT FROM AUTHOR]

Objectives: To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO).Design: Systematic review of the literature and meta-analysis of published data.Data Sources: PubMed, SAGE, MEDLINE, and Cochrane.Review Methods: A literature search was performed and evaluated based on established criteria. Two independent reviewers (b.a., m.b.) inspected titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. An air-bone gap (ABG) of 0 to 10 dB hearing level was described as success of surgery.Results: A random effects model was used to analyze the data. A total of 27 studies were included in the meta-analysis, whereas 934 were excluded. The total number of operated ears was 445 (256 ears with JO and 189 ears with CSF). At the time of surgery, the age of the patients ranged from 3 to 18 years. The success rate was 80.2% for JO and 54% for CSF. The overall success rate was 69.9%. The rate of postoperative sensorineural hearing loss was 3.4% for JO and 2.1% for CSF.Conclusions: Overall, stapes surgery in children with JO or CSF has a moderate success rate (69.9%) to provide ABG closure of 10 dB. The success rate for CSF in the setting of ossicular abnormalities is 54%. This meta-analysis suggests that if JO can be determined before surgery, a higher success rate is possible (80.2%). [ABSTRACT FROM AUTHOR]

Objective: To relate poststapedectomy change in tinnitus loudness to change in tinnitus severity.Study Design: Prospective, within-subjects.Setting: A single otology and neurotology subspecialty referral practice.Subjects and Methods: Forty-nine subjects undergoing stapedectomy completed the study between January 2012 and October 2013. Tinnitus instruments, audiometric data, and demographic information were collected prior to and 1 and 6 months after surgery. Tinnitus loudness was assessed using an 11-point (0 = none; 5 = conversation level; 10 = jet engine) visual analog scale, and severity was measured using the validated Tinnitus Functional Index. The relationship between change in tinnitus loudness and change in tinnitus severity was evaluated using linear regression and receiver operating characteristic (ROC) analyses.Results: A linear regression model of change in tinnitus loudness averaged for both ears on a visual analog scale (ΔVASavg) versus change in Tinnitus Functional Index score (ΔTFI) showed a strong correlation (ΔTFI = 9.35 ×ΔVASavg; R = 0.64; P < .001). An ROC analysis identified ΔVASavg between 1.5 and 2.0 as the optimal threshold for predicting a clinically significant change in tinnitus severity (ΔTFI ≥ 13), with sensitivity and specificity of approximately 0.62 and a positive predictive value (PPV) of 0.64.Conclusion: For poststapedectomy patients, a VAS loudness change by 1.5 to 2.0 points averaged for both ears in bilateral tinnitus or ~3 points in unilateral tinnitus has a PPV ~0.64 for a clinically significant change in tinnitus severity. [ABSTRACT FROM AUTHOR]

The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate. The footplate was fixed. Stapedotomy and stapes prosthesis insertion resulted in closure of the air-bone gap by 50 dB. A review of world literature was performed using MedLine. Middle ear ossicular discontinuity can result in significant conductive hearing loss. This can be managed effectively with surgery to help restore hearing. However, some patients may not be suitable or decline surgical intervention and can be managed safely conservatively. [ABSTRACT FROM AUTHOR]

Facial palsy that occurs immediately after middle ear surgery (stapedectomy, stapedotomy, and tympanoplasty) can be a consequence of the local anesthetics and it regresses completely within a few hours. In the case of delayed facial palsy, the alarming symptom occurs several days or even weeks after uneventful surgery. The mechanism of the neural dysfunction is not readily defined. Surgical stress, intraoperative trauma, or laceration of the chorda tympani nerve with a resultant retrograde facial nerve edema can all be provoking etiological factors. A dehiscent bony facial canal or a multiple microporotic fallopian canal (microtrauma or laser effect) can also contribute to the development of this rare phenomenon. The most popular theory related to the explanation of delayed facial palsy at present is the reactivation of dormant viruses. Both the thermal effect of the laser and the elevation of the tympanomeatal flap can reactivate viruses resting inside the ganglion geniculi, facial nerve, or facial nuclei. The authors report the case histories of a 55-year-old female, and a 45-year-old male who presented with a delayed facial palsy following laser stapedotomy. The clinical characteristics, the therapeutic options, and the possibility of prevention are discussed. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope. Study Design Retrospective study. Methods The subjects were 15 patients (15 ears) who underwent endoscopic stapes surgery for otosclerosis or congenital stapedial fixation. Another 35 patients (41 ears) in whom microscopic stapes surgery was performed by the same surgeon were assigned to the control group. The procedures for endoscopic surgery were fundamentally the same as those for microscopic surgery, unless there was no anterior or posterior auricular skin incision. The two surgical techniques were compared with respect to the operating time, postoperative hearing, complications, postoperative pain, and the extent of drilling at the posterosuperior part of the external auditory canal. Results There were no differences of operating time or postoperative hearing between the endoscopic and microscopic groups. There was very little postoperative pain in the endoscopic group. Postoperative dizziness was mild in all patients who received endoscopic surgery. Drilling at the posterosuperior part of the external auditory canal was less extensive in the endoscopic group than in the microscopic group. Conclusion Endoscopic surgery is particularly suitable for stapedial disease. Endoscopic stapes surgery can even be done in patients with a curved and narrow external auditory canal. Endoscopic surgery is also suitable for education: The surgical anatomy can be understood easily and both the surgeon and assistants can observe the procedure on the same monitor. However, it should only be performed by experienced surgeons because one-handed manipulation is required and stereoscopic vision is not available. Level of Evidence 3b. Laryngoscope, 124:266-271, 2014 [ABSTRACT FROM AUTHOR]

The article offers information on the study which compares the fat, fascia, and vein tissue seals after stapedectomy. It states that the study covers the patients whose ears underwent stapedectomy with placement of fat, fascia, or vein as its oval window seal and same titanium bucket handle prosthesis. It argues that the three types of tissue seals provide the same result for hearing outcomes.

Perilymph fistula (PLF) is defined as a leak of perilymph at the oval or round window. It excludes other conditions with "fistula" tests due to a dehiscent semi circular canal fromcholesteatoma and the superior canal dehiscence syndrome. It was first recognized in the early days of stapedectomy as causing disequilibrium and balance problems before sealing of the stapedectomy with natural tissue became routine. It then became apparent that head trauma and barotraumatic trauma fromflying or diving could be a cause of PLF. Descriptions of "spontaneous" PLF with no trauma history followed. A large literature on PLF from all causes accumulated. It became an almost emotional issue in Otolaryngology with "believers" and "nonbelievers." The main criticisms are a lack of reliable symptoms and diagnostic tests and operative traps in reliably distinguishing a perilymph leak from local anaesthetic. There are extensive reviews on the whole topic, invariably conveying the authors' own experiences and their confirmed views on various aspects. However, a close examination reveals a disparity of definitions and assumptions on symptoms, particularly, vestibular. This is an intentionally provocative paper with suggestions on where some progress might be made. [ABSTRACT FROM AUTHOR]

Objective. To determine the efficacy of using intraoperative auditory brainstem response (ABR) in improving immediate hearing results of patients undergoing primary laser stapedotomy.Study Design. Case series with chart review.Setting. Community hospital.Subjects and Methods. The study included 32 consecutive patients, with 34 ears undergoing primary stapedotomy by a single surgeon at a single institution using a single prosthesis design. Intraoperative ABR was performed at the beginning of each surgery and after the stapes prosthesis was inserted. Surgical adjustments were made if initial ABR results did not demonstrate hearing improvement. ABR then was repeated at the conclusion of the procedure. Audiometry was performed postoperatively in all patients.Results. There were 22 left ears and 12 right ears studied. Two patients underwent bilateral staged surgery. Eight patients, or 23% of the group, had intraoperative adjustments made to improve hearing results. Hearing was improved in 33 of 34 ears, or 97%. The surgical revision rate was 3%. The average preoperative air-bone gap (ABG, calculated as an average from 250, 500, and 1000 Hz) was 29.0 dB HL in the left ear group and 26.6 dB HL in the right ear group. The average postoperative ABG was 9.9 dB HL in the left ear group and 9.4 dB HL in the right ear group. All patients had postoperative audiometric results consistent with final intraoperative ABR results.Conclusion. Intraoperative ABR may significantly improve immediate hearing results in patients and greatly reduce the need for revision surgery. [ABSTRACT FROM PUBLISHER]

Objectives. We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient’s risk of perilymph gusher during stapes surgery. Methods. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations. She elected to proceed with revision stapedectomy. Results. The patient received modest benefit to hearing, and no operative complications occurred. Conclusions. Although stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess the potential carbon dioxide (CO2) and potassium-titanyl-phosphate (KTP) laser-related trauma to the saccule and utricle in a cat model. Study Design: Basic science experiment utilizing cat model. Methods: Twelve adult male cats were divided into two groups-CO2 and KTP-to assess the potential saccule and/or utricle trauma with direct discharge of laser energy into the vestibule after the stapes was removed. Both groups were subdivided to assess the effects with acute sacrifice and three-month survival. Bone conduction auditory brain-stem response thresholds were used to monitor auditory function. Clinical observation was used to monitor vestibular function. The temporal bones were harvested, processed, and stained with hematoxylin and eosin (H&E) in all animals with the uninvolved side serving as the control. Results: None of the animals demonstrated changes in bone conduction auditory brain-stem responses. None of the animals in the survival group demonstrated clinical vestibular dysfunction. Saccular and utricular wall rupture was observed in all animals sacrificed acutely. None of the saccular and utricular wall ruptures were of a size and location that could be attributed to laser trauma, and none of the saccular and utricular wall ruptures were associated with neuroepithelial trauma. Conclusions: There is no evidence of a difference between the CO2 and KTP laser in potential laser-related trauma. Using bone-conducting auditory brain-stem response threshold and clinical monitoring of vestibular function, there was no evidence of clinical auditory or vestibular dysfunction. The histologic evidence of saccular and utricular wall rupture is more consistent with stapes extraction trauma than laser-related trauma. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the early removal of the posterior crus during reversal stapedotomy.

Objectives: To demonstrate that 1) recent graduates of training programs in otorhinolaryngology-head and neck surgery are less likely to recommend/perform stapedectomy than more senior otolaryngologists; and 2) when surgery is recommended, referral is most commonly made to an otologist/neurotologist. Study Design: Survey of 500 regional otolaryngologists pertaining to their treatment of patients with hearing loss secondary to otosclerosis. Methods: Otolaryngologists in community practice were provided with written surveys pertaining to their treatment of otosclerosis. Results: Data were obtained from 179 general otolaryngologists treating adults and children in solo or group private practices in our geographic region. The majority (66%) diagnosed one to five new cases per year. Ten percent of surgeons graduating in the 1970s, 25% graduating in the 1980s, 50% graduating in the 1990s, and 90% of graduates in the 2000s never performed stapedectomy as part of their practices ( P < .001). Similarly, a significant number of surgeons who formerly performed stapedectomies no longer do this surgery. A trend toward greater use of hearing aids for the treatment of otosclerosis was seen in more recent graduates ( P < .08). When surgery was recommended, otologists/neurotologists received the majority of referrals (75%) from the practitioners surveyed. Conclusions: Stapedectomy is performed and recommended less often by more recent graduates of otolaryngology training programs. Training requirements for both general otolaryngologists and neurotologists may need modification given current practice patterns for stapes surgery. [ABSTRACT FROM AUTHOR]

Keypoints • The Causse technique of performing stapedotomy with vein graft interposition is widely-employed, with the vein graft harvested from the dorsum of the hand/wrist. • Donor site scarring may be of cosmetic concern, especially in female patients. • A prospective series of 19 patients undergoing stapedotomy with vein graft harvested from the superficial temporal vein is evaluated from aesthetic and functional perspectives. • Results show that vein interposition from this donor site is not only aesthically acceptable but just as successful in improving hearing outcome after stapedotomy. • We suggest the use of the superficial temporal vein and/or its branches as an alternative vein graft in stapedotomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To present our mid-term results of our multicenter study using the Nitinol self-crimping stapes piston, focusing on the interindividual variations of postoperative air-bone gap closures (ABGC), postoperative hearing results, and postoperative recurrences of conductive hearing loss and to compare these findings with our pilot group of patients. STUDY DESIGN:: Prospective, multicenter cohort study involving three academic tertiary care referral centers from Australia, Switzerland, and the United States. METHODS:: Ninety patients with otosclerosis undergoing laser-stapedotomy with the Nitinol stapes piston were matched to reference patients from our titanium piston database. The effects of the self-crimping Nitinol piston on the postoperative ABGC, the postoperative interindividual air-bone gap (ABG) variations, and the postoperative hearing results were investigated 3, 6, 12, 18, and 24 months postoperatively. These data were statistically compared with the results of the control patients in our titanium stapes piston database and the results of our previously published pilot study. RESULTS:: The mean postoperative ABG and the interindividual variations of the postoperative ABG continue to be significantly smaller in the Nitinol group; the extent of ABGC now is significantly larger in the Nitinol piston group. The postoperative mid-term stability of ABGC was similar in both groups. No adverse reactions occurred during follow-up. CONCLUSION:: Our mid-term results continue to show that the self-crimping shape memory alloy Nitinol stapes piston overcomes the limitations of manual malcrimping in stapedotomy, thus simplifying and optimizing the surgical procedure. This so far has allowed reliable, safe, and consistent ABGC in patients with otosclerosis. [ABSTRACT FROM AUTHOR]

Keypoints • The use of laser for stapedotomy was introduced in our department in the year 2002, and since then has taken over the mechanical technique. • A total of 85 patients who had undergone primary stapedotomy with either technique are reported with regards to effectiveness and rate of side effects. • Although footplate complications were reduced with the laser, short-term hearing outcomes were similar between the two techniques. • In four occasions, the surgeon had to switch back to the mechanical technique unexpectedly. • Stapedotomy will continue to be performed with the laser in our department, bearing in mind the occasional need for the older technique. [ABSTRACT FROM AUTHOR]

Objectives: To determine the quality of life (QOL) after stapes surgery and whether audiological parameters for hearing correlate with specific QOL factors. Design: A retrospective cross-sectional study. Setting: A tertiary referral centre. Participants: A series of 35 patients who underwent stapes surgery of which three were excluded because they were <18 years of age, chronically or mentally ill, or in a dependant relationship. Response rate was 93% (30/32). Nine were further excluded because they had revision or bilateral surgery, or missing data. Twenty-one patients were included in this study. Main outcome measures: The Glasgow Benefit Inventory (GBI) was used to evaluate general QOL and the Hearing Disability and Handicap Scale (HDHS) was used as a disease-specific measure. The Belfast Rule of Thumb and Glasgow Benefit Plot assessed hearing outcomes. Results: Operative success was 86% using the Belfast Rule of Thumb and 95% had closure of the air–bone gap to within 20 dB. 81.8% of patients reported a better overall QOL as surgery. Glasgow Benefit Inventory Social and GBI Physical scores correlated positively with the HDHS speech component ( P < 0.05). The duration of hearing loss correlated inversely with the average HDHS score ( P < 0.05). Conclusion: The majority of patients report a better QOL as undergoing stapes surgery. Speech impacts on people's physical and social QOL of patients. Quality of life tools, in addition to objective audiologic measurements can provide clinicians with patients’ subjective perspective that helps guide clinical decision-making and counselling. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: The objective of this study was to analyze functional results after stapes surgery in patients with congenital nonprogressive conductive deafness resulting from an isolated fixation of the stapes according to age and surgical procedure.STUDY DESIGN:: The authors conducted a retrospective case series from March 1993 to December 2003 in patients from two tertiary referral centers.METHODS:: Twenty-eight patients were operated on by stapedotomy or partial stapedectomy using Teflon stapes prostheses. The median age at surgery was 14.2 years (range, 8.3–29.1 years). Main outcome measures were clinical and audiometric evaluation before and after surgery. Mean air conduction (MAC) and bone conduction (MBC) thresholds were recorded at 0.5, 1, 2, and 4 kHz. The evaluation of functional outcome was based on the MAC gain, the MBC comparison, and the mean postoperative and residual air–bone gaps.RESULTS:: The median preoperative MAC was 50 dB (range, 19.0–65.0 dB) with a 35.0 dB median dB air–bone gap. With a mean follow up of 19 months, postoperative hearing improvement was statistically significant: median gain of 32.5 dB (P < .001) and median residual air–bone gap of 3.5 dB. The MBC was also statistically improved with median pre- and postoperative MBC of 11.5 and 6.5 dB, respectively (P < .001). Results were not dependent on the age group or type of surgery (stapedotomy or partial stapedectomy). No perceptive hearing loss was observed despite one gusher case.CONCLUSION:: Surgical treatment of isolated congenital stapes ankylosis allows good functional results regardless of age or type of surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of two stapes prostheses in hearing improvement of patients undergoing stapes surgery for otosclerosis. Study Design: Retrospective chart review. Methods: Titanium and Teflon wire stapes prostheses were compared with regard to effectiveness in closing the air-bone gap. The charts of 461 stapedectomies performed by one surgeon from 1996 to 2001 were reviewed. Patients who underwent stapedectomy for reasons other than otosclerosis, revision cases, and those with inadequate preoperative or postoperative bone-conduction threshold data were excluded. Small fenestra technique using either laser or drill was used for all patients. Inclusion criteria were met by 218 patients. Patients were then grouped according to type of prosthesis used, and hearing outcomes were compared. Measured outcomes were four frequency air-bone gap closure, pure-tone threshold, and rate of sensorineural hearing loss (SNHL). Results: The study group was comprised of 35 titanium and 183 Teflon wire prostheses. Closure of the air-bone gap to less than 10 dB was achieved in 86% of the patients with Teflon prosthesis compared with 71% of those with titanium prostheses. The groups were equivalent in regard to site of otosclerotic disease as well as technique, laser or drill, used to create the fenestra. Rate of SNHL was low for both groups and not significantly different. Conclusions: Both prostheses provided comparable results, although the Teflon platinum wire prosthesis was slightly superior. The smaller numbers in the titanium group may confound these results. The design of the titanium prosthesis provides a crimp that is circumferential around the incus, and that prosthesis was selected in cases with a narrow incus. The selection bias may also influence the results seen in this study. [ABSTRACT FROM AUTHOR]

salvinelli f., casale m., di peco v., greco f., trivelli m., miele a., d' ascanio l., firrisi l., luccarelli v., alemanno i. & marte c. (2003) Clin. Otolaryngol. 28, 520–523 This prospective study aims to evaluate the efficacy of stapedotomy in relation to age. Eighty-four ears of 82 consecutive patients who underwent stapedotomy were studied. Patients were divided into five groups according to their age. In each patient, we evaluated the pre- and postoperative auditory thresholds, according to the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology – Head and Neck Surgery guidelines. Statistically significant ( P < 0.05) differences between the pre- and postoperative air conduction thresholds were observed in all groups. Statistically significant reductions of air-bone gap were observed at lower-medium frequencies (250, 500 and 1000 Hz) in the elderly as well as in the younger patients. We did not find a higher susceptibility of the inner ear to surgical trauma in the elderly in comparison to the younger patients. Our data show that stapedotomy results in older adults are comparable to those obtained in the younger, without an increased incidence of complications. [ABSTRACT FROM AUTHOR]

SUMMARY: OBJECTIVE/HYPOTHESIS The objective of the study was to investigate predictive factors in the postoperative hearing outcomes in pediatric stapedectomy.STUDY DESIGN Retrospective case series. The study was performed in a tertiary academic otological practice.METHODS The outcome of 66 stapedectomies in children 17 years of age and younger were analyzed according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines. Factors evaluated included patient age, underlying diagnosis (tympanosclerosis, otosclerosis, congenital fixation), type of footplate graft and type of prosthesis used, associated ossicular abnormalities, and revision surgery.RESULTS The mean postoperative air-bone gap following stapedectomy in children with tympanosclerotic footplate fixation (24.9 dB [±11 dB]) was significantly worse than in patients with an underlying diagnosis of congenital stapes fixation (15.7 dB [±9 dB]) or otosclerosis (13.1 dB [±3 dB]) (P = .024). Revision stapedectomy was also associated with a poorer outcome, but patient age and prosthesis and graft type did not contribute to the outcome in a statistically significant manner.CONCLUSIONS Pediatric patients with stapes fixation resulting from tympanosclerosis showed poorer outcomes from stapedectomy than patients with congenital or otosclerotic fixation. Outcomes for congenital or otosclerosis fixation more nearly matched the outcomes in the literature for adult series. [ABSTRACT FROM AUTHOR]

OBJECTIVEThe study describes the technical precautions and short-term hearing results of fast-setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy.STUDY DESIGNObservational and retrospective chart review.METHODSConsecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6-week hearing outcomes comparing preoperative and postoperative air-conduction and bone-conduction thresholds.RESULTSA small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp-on prosthesis may be placed on the cement-lengthened incus. Six-week postoperative audiograms demonstrated significant closure of the air-bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself.CONCLUSIONSIonomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken. [ABSTRACT FROM AUTHOR]

OBJECTIVE/HYPOTHESIS To compare the effectiveness and long-term stability of hearing results between stapedectomy and small fenestra stapedotomy in patients with conductive hearing loss due to otosclerosis.STUDY DESIGN Retrospective review of prospectively collected audiometric data.METHODS The hearing results and complication rates of 209 ears with long-term follow-up that underwent either stapedectomy or stapedotomy by the senior author (h.p.h.) between 1961 and 1989 were compared. Forty-two patients underwent stapedectomy in one ear and stapedotomy in the opposite ear, permitting a paired case review of the results in these patients. The techniques were compared with respect to initial and late hearing results and change of the results over time.RESULTS Patients undergoing stapedectomy and stapedotomy were followed for an average of 11.5 and 6.0 years, respectively. There were no statistically significant differences in initial or late postoperative pure-tone average (PTA), PTA air-bone gap, speech discrimination scores, or incidence of sensorineural hearing loss between the two groups. Ears treated by stapedotomy showed statistically better initial and late postoperative 4-kHz air-conduction threshold and initial 4-kHz air-bone gap, but the gap difference was not significant with late follow-up. There was no significant difference in the percentage of patients with air-bone gap closure within 10 dB for any frequency other than 4 kHz at the initial postoperative test. Importantly, the successful outcomes in both groups were stable over long-term follow-up. Results were the same when comparing the two procedures in patients having undergone both.CONCLUSION These results show that, in the hands of an experienced surgeon, either technique provides satisfactory and stable long-term results. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis A comparison is made of the postoperative long-term hearing results of small fenestra stapedectomy versus large fenestra techniques. Several reports in the literature favor improved hearing results in small fenestra stapedectomy compared with large fenestration and/or total stapedectomy. Methods A retrospective review of 34 patients who had stapedectomy performed by the same surgeon between 1982 and 1992. All patients have been followed for up to 10 years postoperatively. Results In 18 ears of 17 patients, surgery was performed with small fenestra technique, and 17 ears of 17 patients had total stapedectomy or posterior-half fenestration. After small fenestra stapedectomy, initial average air-bone gap at 500, 1000, and 2000 Hz was 9 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated to 4% over the study period. Speech reception thresholds declined 15%. After total or posterior-half stapedectomy the average air-bone gap at 500, 1000, and 2000 Hz was 5 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated 8% and 18% for the small fenestra and large fenestra groups, respectively, over time. Statistically, there was no difference in hearing deterioration rate between these two groups. Conclusions An experienced surgeon can obtain excellent results using either large or small fenestra technique for otosclerosis. After initial successful closure of the air-bone gaps at all measured frequencies, hearing thresholds over the study period were stable for both groups. [ABSTRACT FROM AUTHOR]

Objective the objective was to determine the effectiveness of stapedectomy revision in patients 65 years of age or older. Although stapedectomy revision has been discussed in the literature, as well as primary stapedectomy surgery for elderly patients, we could find no study dedicated to stapedectomy revision in elderly patients. Study Design Retrospective. Methods One hundred twenty patients 65 years of age or older who had a stapedectomy revision between 1980 and 2001 were included. A randomly selected group of 120 patients younger than 65 years of age who had stapedectomy revision were included for comparison. Audiometric results were compared for the two groups. Surgical findings for each group are also discussed. Results The mean pure-tone average hearing improvement for each group was 17.6 dB. The success rate was 70.8% for the elderly group and 67.6% for the younger group. Surgical findings during revision in elderly patients were generally the same as those found for younger patients. Conclusion Advanced age should not be seen as a contraindication to stapedectomy revision. [ABSTRACT FROM AUTHOR]

Objective To report long-term follow up on patients undergoing stapedectomy with the McGee stapes prosthesis. Study Design A retrospective case series. Methods Charts recording 170 stapedectomies (120 primary and 50 revision stapedectomies) from 1989 to 1999 were analyzed, and audiometric data and the findings at repeat exploration reported. Results Over a 10-year period, 11.2% of patients had failure of their initial air-bone gap closure with the McGee piston. Seventy-seven percent (in 10 of 13 patients) of McGee pistons that failed were found to have the platinum ribbon displaced laterally from the incus and the piston pushed out of the stapedotomy. The failure rate was not significantly different ( P = .72) from that in our patients who underwent placement of a Robinson cup prosthesis (9.5%), but the pattern of displacement was unique. Failures occurred earlier with the McGee piston (average time to failure of 2.5 y) than with the Robinson cup (average time to failure of 8.6 y). Conclusion The McGee piston was found to have a unique pattern of dislocation that is likely related to the malleable nature of the platinum ribbon and loosening of the crimped 'shepherd's crook' over time. [ABSTRACT FROM AUTHOR]

A questionnaire was used to collect information related to stapedectomy from all the NHS Trusts in the North West region. The data collected included the identity and rank of the surgeon, the age and sex of the patients, the side of the operation, the audiometric values of the air conduction audiogram preoperatively and postoperatively, and an account of any complications. The results were analysed and compared to national and international standards. The criteria for analysis of success in surgery for conductive hearing loss were reviewed. [ABSTRACT FROM AUTHOR]

Objective To improve the techniques required to perform a stapedotomy without prosthesis (stapedioplasty). Study Design New infrared lasers were evaluated for potential use in otological surgery in guinea pigs. A prospective human trial of 34 primary stapes operations using the Argon ion laser was performed, with 11 stapedioplasties and 23 conventional stapedotomies as controls. Methods Laser-tissue interactions were evaluated for temporal bone and live guinea pig tissues, measuring crater histology and labyrinthine temperature elevations. Patients undergoing stapedioplasty had Argon ion laser cuts with endoscopic assistance made in the anterior crus and footplate to mobilize the posterior segment of the stapes while the anterior portion remained fixed. Results Diode laser (808-nm) vaporization craters and temperature elevations in the vestibule were suitable for clinical use. Overall, stapedioplasty patients' hearing was improved with air-bone gap closure to a mean of 8.3 dB (SD ± 9.8 dB). Conclusions Patients with anterior footplate otosclerosis are candidates for stapedioplasty preserving the annular ring and stapes tendon and eliminating prosthesis complications. High-resolution small endoscopes, coupled with Argon ion or diode lasers promise to improve stapes visualization, enhancing the ability to perform minimally invasive surgery on the stapes footplate. [ABSTRACT FROM AUTHOR]

Two hundred ears with otosclerosis have been operated upon using a 0.4-mm diameter Teflon platinum piston in 100 ears and a 0.6-mm diameter Teflon piston in the other 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the 0.6 mm group for all frequencies except at 2000 Hz, the differencies were statistically insignificant except at 4000 Hz. The mean postoperative air-bone gap was 8.6 dB and 7.4 dB for the 0.4 and 0.6 mm groups, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB, there was a deterioration of more than 10 dB in three ears, one in the 0.4 mm group and two in the 0.6 mm group. According to our results, we conclude that the 0.4 mm and the 0.6 mm Teflon prostheses produce the same hearing improvement in stapes surgery for otosclerosis. [ABSTRACT FROM AUTHOR]

Objective: The safety of scuba diving after stapedectomy is controversial. Stapedectomy is thought to predispose to inner ear barotrauma (e.g., perilymph fistula); however, many individuals continue to scuba dive following stapedectomy without ill effects. The purpose of this study was to evaluate the cochlear effects of barotrauma, similar to that experienced with scuba diving, on inner ears previously treated with stapedectomy. Study Design: Prospective, controlled. Methods: Sixteen Hartley albino guinea pigs underwent unilateral total stapedectomy followed by hyperbaric dives on 5 consecutive days, beginning 3 weeks after stapedectomy. Cochlear effects were determined using click and tone-pip evoked electrocochleographic thresholds and cochlear hair cell counts. Results: Mean auditory thresholds increased by 29 dB after stapedectomy ( P < .001), then remained stable thereafter. Mean thresholds in both the operated and control ears did not change with hyperbaric dives. Evidence of middle ear barotrauma (e.g., hemorrhage or tympanic membrane perforation) was observed in eight poststapedectomy ears and five control ears, but none demonstrated significant threshold elevation greater than or equal to 10 dB. Hair cell counts were not different between operated and control ears. Conclusions: Stapedectomy does not appear to predispose to cochlear sequelae in the guinea pig model of diving-related barotrauma. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the long-term (5-year) results of the shape-memory nitinol stapes piston in the surgical treatment of otosclerosis. Study Design Retrospective case review in a tertiary referral center. Methods The patients were adults with clinically proven otosclerosis undergoing stapedotomy. Stapedotomy and ossicular chain reconstruction using a shape-memory nitinol stapes piston were performed. The main outcome measure was masked air and bone conduction audiometry. Results Forty-eight out of a potential 58 ears had complete audiometric data. The mean preoperative air-bone gap was 29.2 dB (standard deviation [SD] 9.4). The postoperative gap at 1 year was 4.6 dB (SD 3.1), and P at 5 years was 7.0 dB (SD 6.2). Conclusions These data suggest that the Smart piston provides a stable long-term hearing result in the surgical treatment of otosclerosis. Level of Evidence 4. Laryngoscope, 124:2591-2593, 2014 [ABSTRACT FROM AUTHOR]