Search

Although otosclerosis surgery is considered an effective treatment option, there is an incidence of surgical failure that necessitates revision operations. Here, we report a case of revision otosclerosis surgery and propose a new technique for reconstruction of the eroded long process of the incus using a metal wire obtained from a Shepard grommet tympanostomy tube and ionomer bone cement. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is a progressive disease of the otic capsule which presents with conductive hearing loss with an intact tympanic membrane. The description of the disease was first given by Valsalva in 1704. Since then, several techniques are described for otosclerosis. All these procedures have traditionally been performed with microscope. New modifications of surgical techniques have been introduced time to time. The concept of minimally invasive surgical techniques has sprung up lately. Recent advances in optics such as high-definition endoscopes have revolutionized the surgeries in otology. Aim: The study aimed to study the feasibility of primary endoscopic stapedotomy. Objectives: (1) The objectives of the study were to evaluate Air-bone gap (ABG) closure in primary endoscopic stapedotomy and (2) to study intra- and post-operative complications in primary endoscopic stapedotomy. Methodology: Thirty patients with otosclerosis underwent stapedotomy using the standard 0.4 mm 18 cm endoscope and high-definition camera system. Results: Of the 30 cases, 17 were males and 13 were females, with a mean age of 39.84 years. A minimal removal of posterosuperior bony canal wall was required in 21 (70%) cases. The average operative time was 65 min. Among intraoperative complications, chorda tympani injury was seen in 2 (6%) cases, and incus subluxation and stapes footplate subluxation in 1 (3%) case each. Pure-tone audiograms done at an interval of 4 months demonstrated improvement across the three speech frequencies (500-2000 Hz) (50.2 dB vs. 23.7 dB). The average postoperative ABG was within 10 dB in twenty (66%) ears and between 10 and 25 dB in the rest ten (33%) ears. Conclusion: Endoscopic stapedotomy is a good alternative tool to conventional operating microscope. It offers better visualization, less trauma while elevating tympanomeatal flap flap, lesser bone curettage, and provides equivalent results. [ABSTRACT FROM AUTHOR]

Background: A retrospective study done on all otosclerotic patients who underwent stapes surgery between January 2019 and June 2022 in the department of otorhinolaryngology in a tertiary care hospital in North India. Material and Methods: Fifty four patients were enrolled in the study. The inclusion criteria of the study included patients in the age group of 18-55 years with conductive hearing loss and an intact tympanic membrane and an air-bone gap (ABG) of more than 30 dB. Diagnosis of otosclerosis is based on clinical history of progressive hearing loss and audiometric evaluation. Pure Tone Average shows typical conductive hearing loss pattern. Aim and Objective: Preoperative and 6 months postoperative audiological evaluation was conducted to understand the difference in hearing. The same surgical technique was used in all the cases, except that the dimension of the foot plate removed was different. Results: The mean age of patients in years who underwent stapes surgery was 31.6 ± 6.4 years. Out of the 54 patients, 24 (44.44%) were male and 30 (55.56%) were female. The number of patients who underwent large fenestra stapedectomy was 30 (55.56%) and who underwent small fenestra stapedotomy was 24 (44.44%). There was a significant improvement in the hearing parameters (PTA and ABG) in both the groups after surgery, but there was no significant difference between the small fenestra and large fenestra groups in terms of improvement in PTA and ABG. Conclusion: In conclusion, both small fenestra stapedotomy and large fenestra stapedectomy are safe and effective procedures for improving conductive hearing loss in otosclerosis patients. [ABSTRACT FROM AUTHOR]

Background: Stapedotomy is being practiced as a preferred surgical modality for the management of otosclerosis. The operating microscope has been utilized as the conventional tool for stapes surgery over the years. However, certain shortcomings too have been observed. Endoscope provides better and wider field of vision than an operating microscope. Aims and Objectives: The study is aimed to compare the technical challenges faced during microscopic versus endoscopic stapedotomy. Material and Methods: Forty patients with diagnosed otosclerosis were randomly assigned into 2 groups- patients in first group underwent microscopic stapedotomy, while the other group underwent endoscopic stapedotomy. The 2 groups were then observed in terms of extent of the postero- superior canal bone curettage/drilling required for clear visualization of operating area, need for chorda tympani manoeuvring, visualization of the incudo- stapedial complex, operative time, ease of piston insertion, patient head positioning, post-operative pain, vertigo, effect on hearing and taste impairment. Result: Endoscopic stapedotomy offered better access to the oval window requiring less bone removal and chorda tympani manoeuvring. The operating time, pain post operatively, and taste impairment were significantly less in the endoscopic group. No significant difference was observed with respect to hearing outcome and post operative vertigo. Endoscopic stapedotomy had disadvantage of handling the endoscope with one hand and placing the piston with other. Conclusion: Endoscopic stapedotomy has clear cut advantage over microscopic stapedotomy in terms of the technicality and accessibility to the operating area. [ABSTRACT FROM AUTHOR]

Introduction: Otosclerosis is a primary metabolic localized disease characterized by conductive deafness. The mainstay of treatment of this condition remains surgical. Several techniques and approaches are commonly used with largely excellent results. A newly developed piston made of Nitinol has the property of crimping by heat activation rather than manually. This study, carried out at a tertiary care centre of the armed forces, proposed to evaluate the efficacy and complications of the Nitinol Smart piston in comparison to the conventional pistons currently being used. Methods and Materials: 50 patients of otosclerosis were evaluated with Pure tone audiometry and randomized into test and control groups of 25 each. The control group underwent stapedotomy by the conventional Teflon piston and in the test group Nitinol smart pistons were used. Pure tone Audiometry for hearing thresholds and AB gap was performed at 06 weeks after surgery and repeated at 06 months, 01 year and 02 years after surgery. Results: Results show an almost identical outcome in terms of improvement of hearing thresholds with the two kinds of prosthesis used with the 'Smart' piston showing marginally better results. There was no significant difference in the postoperative ABG (P < .23) or ABG closure (P < .09). Conclusion: The nitinol piston prosthesis represents the latest advancement in stapes prosthesis design in that incorporates heat-sensitive crimping to preclude the technically difficult step of manual crimping. It is at least as effective as a standard prosthesis in closing the ABG in patients with otosclerosis. [ABSTRACT FROM AUTHOR]

Objective: To study the hearing results in patients implanted with àWengen titanium clip piston prosthesis after stapedotomy. Methods: In this prospective study, 15 patients of either sex in the age group of 18-50 years having conductive hearing loss with an air-bone gap (ABG) of 30 dB or more, with an intact tympanic membrane, and A or As type of curve in tympanometry were recruited. All patients underwent stapedotomy using àWengen titanium clip piston (Kurz, Germany) which was designed to avoid the scrupulous task of crimping a piston onto the long process of incus. The results were tabulated in accordance with the guidelines set by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994) at frequencies of 0.5, 1, 2 and 3 kHz. The follow-up period was 3 months. Results: The mean preoperative bone conduction (BC) was 16.00 ± 6.02 dB, at 6 weeks postoperative was 16.58 ± 12.40 dB, and at 3 months was 16.00 ± 10.80 dB. The mean preoperative ABG was 42 ± 7.26 dB, at 6 weeks postoperative was 20.5 ± 9.77 dB, and at 3 months was 17.25 ± 10.59 dB. There was improvement in postoperative BC, as well as ABG in 14 patients (except one). Conclusion: The use of the àWengen titanium clip stapes piston gives good results in cases of stapedotomy for otosclerosis. It is easy to insert onto the long process of incus and evades the complex step of crimping. The gain in hearing post surgery is comparable with the other types of pistons reported in literature. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stapedectomy and stapedotomy are the standard techniques for surgical treatment of stapes fixation. Both techniques differ in the size of the created opening in the stapes footplate and the type of prosthesis used. The aim of the study is to evaluate the outcomes of hearing following the two surgical techniques. Methods: One hundred and forty-nine medical records of patients who underwent stapedectomy or stapedotomy between the years 1988 and 2011 were reviewed. The subjects were classified into two groups including stapedectomy and stapedotomy. The clinical and immediate pre- and postoperative air-conduction (AC) threshold, bone conduction, and air-bone gap (ABG) were compared between the two groups. Results: The average age of patients included (n = 149) was 34.4 years at the time of surgery. The pure-tone average calculated for AC for clinical and immediate preoperative and postoperative was 57.6, 58.9, and 35.3 dB, respectively. The ABG calculated for clinical, immediate preoperative, and postoperative was 37, 36.9, and 14.5 dB, respectively. The majority of the patients (80.5%) underwent surgery for otosclerosis. Stapedectomies were done for 60.4% versus 39.6% stapedotomies. Preoperatively, the majority of patients fall within the class of moderate to moderate-severe hearing loss. Closure of ABG to 10 dB or more was achieved in 50.4% of the cases. Postoperative ABG was statistically different (P = 0.002) between the stapedectomy (16.79 dB) versus stapedotomy (10.85 dB) group. Conclusions: Stapedotomy cases were better than stapedectomy ones in closing the ABG. The frequency (250 Hz) AC threshold was better in the stapedotomy group compared to the stapedectomy one in a postoperative audiogram. No statistical difference was observed between the two groups in the other frequencies. [ABSTRACT FROM AUTHOR]

Stapedotomy, though a common surgical procedure for otosclerosis, if inadequately performed, can cause dreaded complications of vertigo and profound hearing loss. Labyrinthectomy with cochlear implantation can be considered in cases of intractable vertigo, as numerous reports have shown that the cochlea still remains responsive to electrical stimulation postlabyrinthectomy. This report presents a case of otosclerosis, with severe to profound deafness and intractable vertigo poststapedotomy surgery, which was treated with simultaneous labyrinthectomy and cochlear implantation. This patient had good control of vertigo postoperatively and the Dizziness Handicap Index score pre-?and post-operative were 80 and 38, respectively, with significant improvement in speech perception. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This prospective randomized controlled trial was done to study the effect of piston diameter on hearing outcomes after stapedotomy. Materials and Methods: All the patients diagnosed to have otosclerosis were included in the study. A total of 52 patients were studied ranging in age from 18 to 50 years. The subjects were randomized into two groups, that is, 0.4 mm piston (group A) and 0.6 mm piston (group B). The subjects were taken up for small fenestra stapedotomy using either a 0.4 or 0.6 mm piston. The main outcome measures were hearing improvement, air-bone gap closure, and overclosure of air-bone gap. Results: There was no statistical difference in hearing improvement in two different piston diameters, 0.4 and 0.6 mm at speech frequencies. In group A, the air-bone gap improvement in the third follow-up was not significant (P > 0.05), whereas group B showed a statistically significant improvement (P = 0.003). The mean overclosure of air-bone gap was better in patients with 0.4 mm piston at speech frequencies and also at 250 Hz. Significantly, overclosure of air-bone gap at higher frequencies (4 and 8 KHz) was seen only with a smaller sized piston. (0.4 mm). Discussion: We analyzed the effect of piston diameter on the hearing results after small fenestra stapedotomy by using similar surgical procedure and similar prosthesis in all patients. Conclusion: There is evidence to suggest that 0.4 mm piston may be better suited for providing optimum hearing results. [ABSTRACT FROM AUTHOR]