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Background: This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively. Methods: Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters. Results: The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant (P <.001). Conclusions: From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time. [ABSTRACT FROM AUTHOR]

Ossicular fixation disturbs the mobility of the ossicular chain and causes conductive hearing loss. To diagnose the lesion area, otologists typically assess ossicular mobility through intraoperative palpation. Quantification of ossicular mobility and evidence-based diagnostic criteria are necessary for accurate assessment of each pathology, because diagnosis via palpation can rely on the surgeons' experiences and skills. In this study, ossicular mobilities were simulated in 92 pathological cases of ossicular fixation as compliances using a finite-element (FE) model of the human middle ear. The validity of the ossicular mobilities obtained from the FE model was verified by comparison with measurements of ossicular mobilities in cadavers using our newly developed intraoperative ossicular mobility measurement system. The fixation-induced changes in hearing were validated by comparison with changes in the stapedial velocities obtained from the FE model with measurements reported in patients and in temporal bones. The 92 cases were classified into four groups by conducting a cluster analysis based on the simulated ossicular compliances. Most importantly, the cases of combined fixation of the malleus and/or the incus with otosclerosis were classified into two different surgical procedure groups by degree of fixation, i.e., malleo-stapedotomy and stapedotomy. These results suggest that pathological characteristics can be detected using quantitatively measured ossicular compliances followed by cluster analysis, and therefore, an effective diagnosis of ossicular fixation is achievable. [ABSTRACT FROM AUTHOR]

Abstract Ossicular fixation disturbs the mobility of the ossicular chain and causes conductive hearing loss. To diagnose the lesion area, otologists typically assess ossicular mobility through intraoperative palpation. Quantification of ossicular mobility and evidence-based diagnostic criteria are necessary for accurate assessment of each pathology, because diagnosis via palpation can rely on the surgeons’ experiences and skills. In this study, ossicular mobilities were simulated in 92 pathological cases of ossicular fixation as compliances using a finite-element (FE) model of the human middle ear. The validity of the ossicular mobilities obtained from the FE model was verified by comparison with measurements of ossicular mobilities in cadavers using our newly developed intraoperative ossicular mobility measurement system. The fixation-induced changes in hearing were validated by comparison with changes in the stapedial velocities obtained from the FE model with measurements reported in patients and in temporal bones. The 92 cases were classified into four groups by conducting a cluster analysis based on the simulated ossicular compliances. Most importantly, the cases of combined fixation of the malleus and/or the incus with otosclerosis were classified into two different surgical procedure groups by degree of fixation, i.e., malleo-stapedotomy and stapedotomy. These results suggest that pathological characteristics can be detected using quantitatively measured ossicular compliances followed by cluster analysis, and therefore, an effective diagnosis of ossicular fixation is achievable.

Otosclerosis is a common cause of hearing loss, yet diagnosing it remains a challenge. Wideband Tympanometry Absorbance (WTA) has been proposed as a potential tool for improving diagnostic accuracy. The aim of study was to investigate the diagnostic value of WTA in diagnosing otosclerosis by comparing its results in patients with clinically diagnosed otosclerosis and a normal control group. This prospective study was conducted in Mashhad, Iran, from 2022 to 2023, involving 64 participants including otosclerosis and control. Inclusion criteria for the otosclerosis group included a clinical diagnosis of otosclerosis confirmed by audiometric tests and conventional tympanometry, and eligibility for surgical intervention. The control group consisted of individuals with normal clinical audiometric and tympanometric results. Both groups underwent conventional and WTA tympanometric assessments. The evaluation of WTA involved 64 participants, divided evenly between otosclerosis a normal ears group. Conventional tympanometry at 226 Hz showed significant differences in compliance between otosclerosis and normal ears (p = 0.02). In contrast, at 1000 Hz did not demonstrate significant differences in compliance (p = 0.2). Also, WTA did not demonstrate significant differences in compliance (p > 0.9). Measurements of gradient and resonance across both 226 and 1000Hz frequencies showed no statistically significant differences. The sensitivity and specificity of WTA, evaluated through compliance, were 72% and 40%, respectively, with an area under the curve of 0.50. The study illustrates that while conventional tympanometry is effective in distinguishing otosclerosis from normal tympanic conditions, WTA shows limited diagnostic efficacy. The moderate sensitivity and specificity of WTA suggest that it should not be relied upon as the sole diagnostic tool. [ABSTRACT FROM AUTHOR]

Background/Objectives: Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. Methods: The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients’ ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air–bone gap (ABG) were examined. Results: After a year, the air–bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. Conclusions: Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood.

Background: Enlarged vestibular aqueduct (EVA) syndrome can mimic otosclerosis in adults, presenting with an air–bone gap (ABG) and even absent stapedial reflexes. The ABG in inner-ear disorders is currently the object of several authors’ studies and seems to be related to a third mobile window (TMW) phenomenon. This can lead to misdiagnosis and inappropriate treatment. Given that it would be inappropriate and harmful to perform CT scans in all patients with a clinical diagnosis of otosclerosis, this study aims to highlight some clinical features useful for the differential diagnosis between otosclerosis and these rare cases of EVA presenting with an ABG, thus enabling the identification of suspected cases to be tested with CT scans. Methods: Between April and May 2024, a narrative review was conducted focusing on the differential diagnosis between some rare cases of EVA and otosclerosis. Clinical, audiological, and radiologic features of both conditions were investigated. Results: This review demonstrates the diagnostic challenge in differentiating atypical cases of EVA from otosclerosis in a subset of patients. Clinical and audiological features are important for differential diagnosis, but may not always be sufficient. Therefore, high-resolution computed tomography (HRCT) of the temporal bone plays a pivotal role in definitive diagnosis. Conclusions: In some specific cases, pre-operative imaging assessment using HRCT emerges as an essential tool for differentiating these two conditions and avoiding unnecessary stapes surgery.

Abstract Background The standard methods for diagnosing otosclerosis (OS) include clinical and audiological testing. Radiologic imaging continues to expand with use in diagnosis, staging, surgery planning, and outcomes. Objective To determine if high resolution computed tomography (HRCT) imaging advances to the audiological findings in the diagnosis of otosclerosis. Methods This prospective randomized controlled study was conducted from June 2018 to June 2022. Fifty patients with OS who divided into two subgroups: group 2a, 50 early OS ears, and group 2b, 35 ears with late OS. The controls includes 50 individuals who have healthy ears (group 1). All participants had otorhinolaryngology examination, audiological evaluation and HRCT imaging. Results Early OS had higher air conduction thresholds than control, and late OS had considerably higher air conduction thresholds than either the early or control subjects (p

Active middle ear implants (AMEI) amplify mechanical vibrations in the middle ear and transmit them to the cochlea. The AMEI includes a floating mass transducer (FMT) that can be placed using two different surgical approaches: "oval window (OW) vibroplasty" and "round window (RW) vibroplasty." The OW and RW are windows located on the cochlea. Normally, sound stimulus is transmitted from the middle ear to cochlea via the OW. RW vibroplasty has been suggested as an alternative method due to the difficulty of applying OW vibroplasty in patients with ossicle dysfunction. Several reports compare the advantages of each approach through pre and postoperative hearing tests. However, quantitatively assessing the treatment effect is challenging due to individual differences in pathologies. This study investigates the vibration transmission efficiency of each surgical approach using a finite-element model of the human cochlea. Vibration of the basilar membrane (BM) of the cochlea is simulated by applying the stimulus through the OW or RW. Pathological conditions, such as impaired stapes mobility, are simulated by increasing the stiffness of the stapedial annular ligament. RW closure due to chronic middle ear diseases is a common clinical occurrence and is simulated by increasing the stiffness of the RW membrane in the model. The results show that the vibration amplitude of the BM is larger when the stimulus is applied to the RW compared to the OW, except for cases of RW membrane ossification. The difference in these amplitudes is particularly significant when stapedial mobility is limited. These results suggest that RW vibroplasty would be advantageous, especially in cases of accompanying stapedial mobility impairment. Additionally, it is suggested that transitioning to OW vibroplasty could still ensure a sufficient level of vibratory transmission efficiency when placing the FMT on the RW membrane is di cult due to anatomical problems in the tympanic cavity or confirmed severe pathological conditions around the RW. [ABSTRACT FROM AUTHOR]

Background/Objectives: Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. Methods: The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients' ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air–bone gap (ABG) were examined. Results: After a year, the air–bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. Conclusions: Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood. [ABSTRACT FROM AUTHOR]

Background: Enlarged vestibular aqueduct (EVA) syndrome can mimic otosclerosis in adults, presenting with an air–bone gap (ABG) and even absent stapedial reflexes. The ABG in inner-ear disorders is currently the object of several authors' studies and seems to be related to a third mobile window (TMW) phenomenon. This can lead to misdiagnosis and inappropriate treatment. Given that it would be inappropriate and harmful to perform CT scans in all patients with a clinical diagnosis of otosclerosis, this study aims to highlight some clinical features useful for the differential diagnosis between otosclerosis and these rare cases of EVA presenting with an ABG, thus enabling the identification of suspected cases to be tested with CT scans. Methods: Between April and May 2024, a narrative review was conducted focusing on the differential diagnosis between some rare cases of EVA and otosclerosis. Clinical, audiological, and radiologic features of both conditions were investigated. Results: This review demonstrates the diagnostic challenge in differentiating atypical cases of EVA from otosclerosis in a subset of patients. Clinical and audiological features are important for differential diagnosis, but may not always be sufficient. Therefore, high-resolution computed tomography (HRCT) of the temporal bone plays a pivotal role in definitive diagnosis. Conclusions: In some specific cases, pre-operative imaging assessment using HRCT emerges as an essential tool for differentiating these two conditions and avoiding unnecessary stapes surgery. [ABSTRACT FROM AUTHOR]

Otosclerosis is a complex skeletal condition that originates from both hereditary and environmental factors. Gradual conductive hearing loss is the main character. Aim to contrast and assess the postoperative results, such as hearing improvement, following the use of bone cement to fix the Titanium versus Teflon stapes piston. 50 patients who had endoscopic stapedotomy with different prostheses insertions were included in this prospective, randomized research. They were splitted into two groups in the: group A consisted of 25 ears in which titanium prostheses with bone cement were applied, while group B consisted of 25 ears Teflon prostheses with bone cement were used. A statistically significant difference was observed in average air conduction (better hearing) between groups A and B at 3, 6, and 12 months postoperatively based on audiometric results. When comparing groups B and A after 3, 6, and 12 months after surgery, the average air bone gap (ABG) was greater in group B, and this difference was statistically significant. Between the two groups, there was no discernible variation in any of the preoperative metrics. 96% of groups A and B were successful. Using bone cement in primary stapedotomy may help fix the procedure and reduce the chance of persistent hearing loss in patients with otosclerosis. This is especially true when titanium is used, as titanium has the ideal mass and stiffness to support acoustic transmission with a low rate of adverse effects and better average ABG. [ABSTRACT FROM AUTHOR]

Background: The standard methods for diagnosing otosclerosis (OS) include clinical and audiological testing. Radiologic imaging continues to expand with use in diagnosis, staging, surgery planning, and outcomes. Objective: To determine if high resolution computed tomography (HRCT) imaging advances to the audiological findings in the diagnosis of otosclerosis. Methods: This prospective randomized controlled study was conducted from June 2018 to June 2022. Fifty patients with OS who divided into two subgroups: group 2a, 50 early OS ears, and group 2b, 35 ears with late OS. The controls includes 50 individuals who have healthy ears (group 1). All participants had otorhinolaryngology examination, audiological evaluation and HRCT imaging. Results: Early OS had higher air conduction thresholds than control, and late OS had considerably higher air conduction thresholds than either the early or control subjects (p < 0.001). Early OS patients had higher bone conduction threshold (BCT) than control, while late OS patients had higher BCT than both early and control subjects (p < 0.001). In early and late OS, there is a significant association between bone conduction of 11 dB and 21.6 dB, respectively (P = 0.004), and a significant air–bone gap of 25.5 and 31 dB, respectively (P = 0.03). HRCT showed a sensitivity of 75% and high specificity 92% with accuracy 83% in early OS and sensitivity of 78% and high specificity 94% with accuracy 86% in late OS. Conclusion: HRCT is a more sensitive and specific diagnostic tool for OS than audiometry. HRCT could discriminate between early and late OS, suggesting that it can be used to do so with a high degree of confidence. [ABSTRACT FROM AUTHOR]

To assess the post-operative cases of stapes surgery. To determine correction in hearing loss post surgery and changing trends over 50 years. In a retrospective observational study, 234 cases otosclerosis who underwent surgical management between 1973 and 2023 were assessed. A total of 234 cases were seen. Male:female ratio was 0.8:1. Most patients were in the age group 21–30. Left > right ear involvement was seen. Stapedotomy > stapedectomy was the surgical procedure done. More than 50% patients had around 30db improvement in audiometric evaluation post surgery. Most common complications were vertigo and nystagmus which were seen more post stapedectomy as compared to stapedotomy. Sensorineural hearing loss is a rare complication and was seen exclusively post stapedectomy. We conclude that stapes surgery is beneficial in improving hearing capabilities with no difference as per change in surgical approach. Stapedectomy being more radical has more predisposition to vertigo and nystagmus post surgery. Post-operative complications has reduced with course of time due to improvement in surgical equipments and pre-op investigations. [ABSTRACT FROM AUTHOR]

Introduction: Otosclerosis (OTSC) is one of the most common causes of progressive adult-onset hearing loss in the Caucasian population, with a female preponderance. The etiology of OTSC is complex and there are a number of genetic variants reported to be associated with OTSC susceptibility, but no data on the genetic background of OTSC in patients originating from the central-eastern part of Europe have been available. The purpose of our study was to investigate in Polish patients the frequency of genetic variants previously reported to be most strongly associated with OTSC. Material and methods: Genomic DNA was isolated from blood samples or buccal swabs. Variants in TGFB1 (rs1800472) and RELN (rs39335, rs39350, rs39374) were genotyped in surgically confirmed OTSC patients (n = 94) and a control group (n = 198) using custom TaqMan SNP genotyping assays and real-time PCR. Allele and genotype frequencies were compared between the groups in statistical analysis and the odds ratios with 95% confidence intervals were calculated to estimate the risk. Results: For all of the tested variants the distributions of alleles and genotypes were not statistically significantly different between OTCS patients and the control group. There were also no statistically significant differences in relation to gender of the tested subjects. Conclusions: Despite multiple confirmatory studies on TGFB1 and RELN association with OTSC development in some populations, no significant association between the studied variants and OTSC was found in Polish patients. Our results indicate the presence of inter-population differences in OTSC susceptibility factors and confirm the large genetic heterogeneity of this disorder. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate and compare the surgical outcomes of endoscopic malleostapedotomy (EMS) and endoscopic incudostapedotomy (EIS). Methods: A retrospective analysis was conducted on 36 consecutive ears in 33 patients who underwent stapes surgery using either EMS (EMS group) or EIS (EIS group). Operational practicability across surgical steps, postoperative hearing, operation time, switch of approach, and complications were compared between the two groups. Results: The EMS and EIS groups comprised seven (19.4%) and 29 ears (80.6%), respectively. The EMS group exhibited a greater proportion of moderate practicability in anchoring site exposure (42.9%, three of seven) and in securing the prosthesis (100%, seven of seven) in comparison to the EIS group, which had 0% (0 out of 29) and 41.4% (12 out of 29), respectively. Postoperative hearing improvements were equivalent between the groups, with EMS achieving a mean air-bone gap improvement of 28.8 dB and EIS of 23.2 dB. The ABG closure rates within 10 dB and 20 dB for the EMS group were 28.6% and 100%, respectively, and not significantly different from the EIS group (p = .103). However, the average surgical duration for EMS was extended by 77.4 min. The rate of complications was comparable between the groups (EMS 14.3%, EIS 10.3%, p = 1.000). Conclusion: The findings indicate that while EMS requires a longer operation time because of decreased practicability in specific surgical steps, it provides comparable outcomes to EIS, underscoring the potential of endoscopic techniques to establish malleostapedotomy as a surgical option as it is with traditional incudostapedotomy. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative dizziness has been associated with stapedotomy. In 1981, intratympanic dexamethasone was utilized to manage inner ear disorders like tinnitus and acute sensorineural hearing loss. However, there is much uncertainty regarding the effect and safety of topical steroid therapy in the middle ear during stapedotomy. In the present study, we assessed the effect of topical steroid therapy during stapedotomy on postoperative dizziness. Methods: Otosclerosis patients eligible for stapedotomy were randomly divided into two groups based on dexamethasone administration or placebo. Audiometric and tympanometry results were observed and recorded for the involved frequencies. The Dizziness Handicap Inventory was used to quantify patient perceptions of dizziness and balance issues. Audiometry and dizziness assessments were repeated at discharge and 4 months after the operation. Results: The study comprised 72 otosclerosis patients undergoing stapedotomy. At discharge, the intervention group showed a significant reduction in the incidence of dizziness compared to the placebo group. However, in the 4-month follow-up after the operation, both groups experienced a decrease in dizziness incidence, with no significant difference between them. There was also no significant difference in audiometric levels between the two groups. Interestingly, the intervention group had a significantly lower need for systemic anti-dizziness drugs after surgery compared to the control group. Conclusion: Topical dexamethasone during stapedotomy effectively minimizes dizziness at discharge and reduces the need for postoperative anti-dizziness medication. [ABSTRACT FROM AUTHOR]

HYPOTHESIS: Na + , K + -ATPase (Na/K-ATPase) α1 subunit expression in the saccule of patients diagnosed with otologic disease is different compared with normal controls. BACKGROUND: We have recently characterized changes in the expression of Na/K-ATPase α1 subunit in the normal and pathological cochlea; however, no studies have determined the distribution Na/K-ATPase α1 subunit in the human saccule. The present study uses archival temporal bones to study the expression Na/K-ATPase α1 subunit in the human saccule. METHODS: Archival celloidin formalin fixed 20-micron thick sections of the vestibule from patients diagnosed with Menières disease (n = 5), otosclerosis (n = 5), sensorineural hearing loss, and normal hearing and balance (n = 5) were analyzed. Sections containing the saccular macula were immunoreacted with mouse monoclonal antibodies against Na/K-ATPase α1 subunit. Micrographs were acquired using a high-resolution digital camera coupled to a light inverted microscope. RESULTS: In the normal human saccule vestibular sensory epithelium, Na/K-ATPase α1 immunoreactivity (IR) was present in nerve fibers and calyces that surround type I vestibular hair cells and nerve terminals. The transition epithelium cells were also Na/K-ATPase α1 immunoreactive. Comparison between normal and pathological specimens showed that there was a significant reduction of Na/K-ATPase α1 IR in the saccule vestibular sensory epithelium from patients with Menières disease, otosclerosis, and sensorineural hearing loss. CONCLUSIONS: The decrease of Na/K-ATPase-IR α1 in the saccule vestibular sensory epithelium from patients with otopathologies suggests its critical role in inner ear homeostasis and pathology.

Objective To analyze the changes in tinnitus after stapedotomy combined with artificial stapes implantation， and further explore the factors influencing the efficacy of postoperative tinnitus in patients with otosclerosis. Methods A total of 54 patients （65 ears） with otosclerosis complicated with tinnitus symptoms who underwent stapedotomy combined with artificial stapes implantation were enrolled. The hearing test results of all patients before surgery， 1 and 6 months after surgery were recorded. The scores of Tinnitus Handicap Inventory （THI） and Clinical Global Impression Scale （CGI-S） before surgery， 1 and 6 months after surgery were compared. Results Before surgery， low-frequency （P < 0.001 and P = 0.013）. At postoperative 1 month， the changes in subjective tinnitus， such as the average air conduction and bone conduction thresholds significantly differed from those before surgery （all P < 0.001）， whereas there was no statistical significance in air-bone gap （P > 0.05）. Conclusions Stapedotomy combined with artificial stapes implantation can not only restore the hearing of patients with otosclerosis， but also mitigate the tinnitus symptoms in most patients. Patients with low- and medium-frequency tinnitus before surgery can obtain more significant improvements in tinnitus after surgery than those with high-frequency tinnitus.

Background and Objectives: Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the surgical steps in stapedotomy impacts vestibular function and hearing improvement. Materials and Methods: A cohort of 123 patients underwent either classic or reverse stapedotomy procedures utilizing a fiber–optic argon laser. Audiological assessments, following the guidelines of the Committee on Hearing and Equilibrium, were conducted, including pure tone average, air–bone (AB) gap, overclosure, and AB gap closure. Vestibular evaluation involved pre- and postoperative comparison of rotatory test parameters, including frequency, amplitude, and slow phase velocity of nystagmus. Results: The study demonstrated an overall median overclosure of 3.3 (3.3, 5.0) dB and a mean AB gap closure of 20.3 ± 8.8 dB. Postoperative median AB gap was 7.5 (7.5, 11.3) dB in the reverse stapedotomy group and 10.0 (10.0, 12.5) dB in the classic stapedotomy group. While overclosure and AB gap closure were marginally superior in the reverse stapedotomy group, these differences did not reach statistical significance. No significant disparities were observed in the frequency, slow phase velocity, or amplitude of nystagmus in the rotational test. Conclusions: Although not always possible, reverse stapedotomy proved to be a safe surgical technique regarding postoperative outcomes. Its adoption may mitigate risks associated with floating footplate, sensorineural hearing loss, and incus luxation/subluxation, while facilitating the learning curve for less experienced ear surgeons. [ABSTRACT FROM AUTHOR]

Objective: The presence of Carhart's notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart's notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart's notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart's notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart's notch. Results: The analysis indicated that Cahart's notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart's notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart's notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart's notch. (2) Disappearance of Cahart's notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart's notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis. [ABSTRACT FROM AUTHOR]

Introduction: We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable resemblance to Ménière's disease and otosclerosis. The occurrence of these cases in such a short period has prompted a review of the underlying causes of its development. Understanding the pathophysiology of third mobile window syndrome and considering these entities in the differential diagnosis of conditions presenting with vertigo and hearing loss with slight air-bone gaps is essential for comprehending this group of pathologies. Materials and Methods: A descriptive retrospective cohort study of six cases diagnosed at a tertiary center. All of them went through auditive and vestibular examinations before and after a therapeutic strategy was performed. Results: Out of 84 cases of dehiscences described in our center during the period from 2014 to 2024, 78 belonged to superior semicircular canal dehiscence, while 6 were other otic capsule dehiscences. Among these six patients with a mean age of 47.17 years (range: 18–73), all had some form of otic capsule dehiscence with auditory and/or vestibular repercussions, measured through hearing and vestibular tests, with abnormalities in the results in five out of six patients. Two of them were diagnosed with Ménière's disease (MD). Another two had cochleo-vestibular hydrops without meeting the diagnostic criteria for MD. In two cases, the otic capsule dehiscence diagnosis resulted from an intraoperative complication due to a gusher phenomenon, while in one case, it was an accidental radiological finding. All responded well to the proposed treatment, whether medical or surgical, if needed. Conclusions: Otic capsule dehiscences are relatively new and unfamiliar entities that should be considered when faced with cases clinically suggestive of Ménière's disease, with discrepancies in complementary tests or a poor response to treatment. While high-sensitivity and specificity audiovestibular tests exist, completing the study with imaging, especially petrous bone CT scans, is necessary to locate and characterize the otic capsule defect responsible for the clinical presentation. [ABSTRACT FROM AUTHOR]

Introduction The early geneticist and psychiatrist Ernst Rüdin (1874–1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi era. His connections in the international eugenics network have played an important role in the history of eugenics. Objective To discuss the connections between Ernst Rüdin's scientific group in Munich and Otmar von Verschuer's group in Frankfurt during the Nazi era. Methods Otorhinolaryngological materials from Ernst Rüdin's former private library are presented, and they show Rüdin's deep involvement in the international eugenics network. These materials provide insights into early medical genetics in otorhinolaryngology. Results One result of the present study is that eugenics groups from Munich, Frankfurt, and New York certainly influenced one another in the field of otorhinolaryngology. Karlheinz Idelberger and Josef Mengele were two scientists who performed hereditary research on orofacial clefts. Later, Mengele became deeply involved in Nazi medical crimes. His former work on orofacial clefts clearly had, to some extent, an influence on subsequent studies. Conclusion An international eugenics network already existed before 1933. However, it becomes clear that the weaknesses of many early genetic studies did not enable its authors to draw firm scientific conclusions, suggesting that scientists lacked an accurate concept of the genetic causes of most illnesses. [ABSTRACT FROM AUTHOR]

(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech–language training may be necessary to reach satisfactory results. [ABSTRACT FROM AUTHOR]

Background: A common form of conductive hearing loss in adults is otosclerosis in otosclerosis there is deposition of new spongy bone in the footplate of stapes and it is more common in females and it is presented mainly with hearing loss, although tinnitus and vertigo may occur. Objectives: Early detection of the disease to improve the patient disability and prevent its progression and, Highlight that otosclerosis is not a rare disease in Iraq. Methods: A retrospective study was carried out between 2019-2022 in private center of hearing and balance in Baghdad including persons who presented with hearing loss and their ages were above 20. Results: There are 8683 persons included in the study, 52 of them were diagnosed with bilateral otosclerosis with prevalence of 0.56 for each 100 patients. [ABSTRACT FROM AUTHOR]

Otosclerosis is a multifactorial bone disorder that affects the otic capsule; otosclerosis is a significant cause of deafness in adults. Since the lesion areas are frequently subtle, the diagnosis of otosclerosis on temporal bone CT images tends to be difficult, especially for fenestral otosclerosis. We design a deep learning model for diagnosing otosclerosis on CT scans in the case of limited samples. That is, we design a dual graph network, namely, ADP-GNN, for predicting otosclerosis-positive and otosclerosis-negative samples; the network consists of point graphs and distribution graphs. More specifically, the point graph is used to model the instance-level relation between nodes, and the risk factors are integrated into it for multimodal diagnosis. The distribution graph is used to model the distribution-level relation between samples, and the copula function is introduced to better measure the dependency between nodes. The autometric strategy is also used to make the model more flexible and to enable the sample to be evaluated independently. Through the propagation between the two graphs and metatraining, the labels of unknown nodes can be predicted. Test experiments on otosclerosis datasets show that the performance of our model achieves accuracies of 98.15% and 97.69% for diagnosis in the left and right ears, respectively, and outperforms the other models. This verifies the advantage of our model in the case of limited samples. We also conduct experiments on a public dataset. The results demonstrate the stability of our model and that it achieves better performance when compared with existing studies. This work offers a new approach for the diagnosis of otosclerosis and facilitates the development of computer-aided diagnosis in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim was to assess the hearing outcomes in cochlear implant patients with far-advanced otosclerosis who had previously undergone stapes surgery. METHODS: We studied 17 implanted patients with far-advanced otosclerosis who had previously undergone stapes surgery. They comprised 15 women and 2 men, aged 37-73 years; the duration of hearing impairment was 9-42 years. Pure-tone audiometry (0.125-8 kHz) was performed preoperatively and at 1, 6, and 12 months postoperatively. Free-field speech audiometry was conducted before and 12 months after surgery, and word recognition scores were assessed. RESULTS: Average preoperative hearing thresholds were 108 dB HL for air conduction and were at the limit of the audiometer for bone conduction. Word recognition scores before surgery averaged 7.4% (at 70 dB) and increased significantly to 66.2% about 12 months after surgery. Adverse surgical events were rare. CONCLUSION: Patients with far-advanced otosclerosis and who have previously undergone stapes surgery are likely to experience a deterioration in hearing and receive insufficient benefits from hearing aids. Cochlear implantation can improve their hearing and provide good speech understanding. [ABSTRACT FROM AUTHOR]

Objective To analyze the changes in tinnitus after stapedotomy combined with artificial stapes implantation, and further explore the factors influencing the efficacy of postoperative tinnitus in patients with otosclerosis. Methods A total of 54 patients (65 ears) with otosclerosis complicated with tinnitus symptoms who underwent stapedotomy combined with artificial stapes implantation were enrolled. The hearing test results of all patients before surgery, 1 and 6 months after surgery were recorded. The scores of Tinnitus Handicap Inventory (THI) and Clinical Global Impression Scale (CGI-S) before surgery, 1 and 6 months after surgery were compared. Results Before surgery, low-frequency (<1 kHz) tinnitus was observed in 31 ears (47.7%), medium-frequency (1-4 kHz) tinnitus in 14 ears (21.5%), and high-frequency (≥ 4 kHz) tinnitus in 20 ears (30.8%). At 1 month after surgery, tinnitus symptom was alleviated in 48 ears (73.8%)(complete healing and mitigation of tinnitus), no changes in 16 ears (24.6%), and tinnitus symptom was aggravated in 1 ear (1.5%). At 6 months after surgery, tinnitus symptom was eased in 50 ears (76.9%), no changes in 13 ears (20.0%), and tinnitus symptom was aggravated in 1 ear (1.5%). Patients with low- and medium-frequency tinnitus obtained more significant improvement in tinnitus compared with their counterparts with high-frequency tinnitus (P < 0.001 and P = 0.013). At postoperative 1 month, the changes in subjective tinnitus, such as the average air conduction and bone conduction thresholds significantly differed from those before surgery (all P < 0.001), whereas there was no statistical significance in air-bone gap (P > 0.05). Conclusions Stapedotomy combined with artificial stapes implantation can not only restore the hearing of patients with otosclerosis, but also mitigate the tinnitus symptoms in most patients. Patients with low- and medium-frequency tinnitus before surgery can obtain more significant improvements in tinnitus after surgery than those with high-frequency tinnitus. [ABSTRACT FROM AUTHOR]

Abstract Background Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative dizziness has been associated with stapedotomy. In 1981, intratympanic dexamethasone was utilized to manage inner ear disorders like tinnitus and acute sensorineural hearing loss. However, there is much uncertainty regarding the effect and safety of topical steroid therapy in the middle ear during stapedotomy. In the present study, we assessed the effect of topical steroid therapy during stapedotomy on postoperative dizziness. Methods Otosclerosis patients eligible for stapedotomy were randomly divided into two groups based on dexamethasone administration or placebo. Audiometric and tympanometry results were observed and recorded for the involved frequencies. The Dizziness Handicap Inventory was used to quantify patient perceptions of dizziness and balance issues. Audiometry and dizziness assessments were repeated at discharge and 4 months after the operation. Results The study comprised 72 otosclerosis patients undergoing stapedotomy. At discharge, the intervention group showed a significant reduction in the incidence of dizziness compared to the placebo group. However, in the 4‐month follow‐up after the operation, both groups experienced a decrease in dizziness incidence, with no significant difference between them. There was also no significant difference in audiometric levels between the two groups. Interestingly, the intervention group had a significantly lower need for systemic anti‐dizziness drugs after surgery compared to the control group. Conclusion Topical dexamethasone during stapedotomy effectively minimizes dizziness at discharge and reduces the need for postoperative anti‐dizziness medication. Level of evidence 2.

AbstractTo report an adverse event after successful otosclerosis surgery: piston extrusion through the tympanic membrane, and its surgical solution. Four patients with a history of stapes surgery in context of otosclerosis presented with recurrent conductive hearing loss due to piston extrusion. Otoscopy, audiometric assessment and CT-imaging were conducted to assess the encountered conductive hearing loss and extrusion of the prosthesis. Revision stapes surgery was performed with interposition of cartilage between tympanic membrane and piston-loop. Pre- and postoperative audiometry and otoscopic evaluation. Revision surgery resulted in postoperative ABG within 15 dB. No recurrent extrusion was seen after the mentioned surgical procedure including use of cartilage graft. In case of piston extrusion (trans-tympanic membrane), revision stapes surgery with interposition of a cartilage layer between tympanic membrane and piston is advocated to prevent recurrence.

Objective: To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis. Methods: In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis. Results: Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds (P <.0001), bone conduction (BC) thresholds (P =.025), and air-bone gaps (ABGs; P <.0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r =.650, P <.001 and r =.745, P <.001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r =.893, P <.001 and r =.476, P =.014, respectively), and in postoperative and preoperative ABGs (r =.933, P <.001 and r =.626, P <.001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes. Conclusions: We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate. [ABSTRACT FROM AUTHOR]

We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis. [ABSTRACT FROM AUTHOR]

Stapedotomy is an effective surgical intervention used for the treatment of conductive hearing loss associated with otosclerosis. The present study aims to quantitatively evaluate the hearing outcomes following primary stapedotomy performed in patients with otosclerosis. It also aims to investigate frequency-specific hearing results of stapedotomy in these patients. This retrospective study enrolled 49 patients with clinical otosclerosis, who underwent primary stapedotomy at a tertiary-care hospital, between January 2014 and December 2019. Pure-tone audiometry (PTA) was performed pre and post-operatively (> 1 year after surgery). Post-operative air conduction (AC) and bone conduction (BC) thresholds were recorded. The primary outcome measure was post-operative air–bone gap (ABG). Low frequency (LF) ABG was calculated as the mean ABG of thresholds at 0.5 and 1 kHz. High frequency (HF) ABG was calculated as the mean ABG of thresholds recorded at 2 and 4 kHz. In all the study patients, the mean post-operative AC and the mean postoperative BC thresholds, showed significant improvement across the tested frequencies of 0.5, 1, 2 and 4 kHz (P < 0.05). The mean post-operative ABG closure was superior at HF, as compared to that at LF (9.54 ± 6.30 dB vs. 12.0 ± 6.63 dB, P = 0.014). A successful surgical outcome (post-operative ABG closure to ≤ 10 dB) was achieved in 61.22% of the study patients. Further, a greater number of patients (71.45%) recorded successful surgical outcome at HF, when compared with those at LF (46.95%, P < 0.05). Favourable hearing outcomes of this study underscore the effectiveness of primary stapedotomy in the treatment of patients with clinical otosclerosis. Better postoperative ABG closure to ≤ 10 dB was recorded at higher frequencies. Further studies assessing post-stapedotomy hearing results at HF are warranted for ensuring better hearing outcomes in the HF range as well. [ABSTRACT FROM AUTHOR]

Conductive hearing loss with a normal tympanic membrane is a common reason for otolaryngology consultation, with otospongiosis being the most frequent cause and House syndrome being extremely rare, requiring systematic investigation. We report the case of a 31-year-old woman who presented with conductive hearing loss with a normal tympanic membrane. A temporal bone computed tomography (CT) scan confirmed a House-Goodhill syndrome due to fixation of the malleus head. Surgical intervention was considered to remove the attic bone synostosis with the malleus head, resulting in a significant clinical improvement. The Goodhill syndrome is a rare condition that causes hearing loss with a normal eardrum. The surgery can highly improve the hearing function. [ABSTRACT FROM AUTHOR]

Introduction Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. Objective To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. Data Synthesis A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. Endoscopic stapes surgery or stapedotomy were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies. [ABSTRACT FROM AUTHOR]

Background: To compare the reporting of high-resolution computed tomography of temporal bones for otosclerosis by general radiologists and a neurotologist within a tertiary-care hospital. Methods: A retrospective review of temporal bone high-resolution computed tomography reports of surgically confirmed otosclerosis patients obtained between 2011 and 2020 was performed at a single tertiary-care center. For comparison, the high-resolution computed tomography reports of all patients performed by the general radiologists and the preoperative patient image evaluation notes of the senior neurotologist were reviewed from the medical records. The main outcome measure was the correct identification of otosclerosis on HRCT. Results: A total of 42 patients (47 ears) were included in the study. The neurotologist correctly diagnosed otosclerosis in 31 of 47 images (66.0%) and the general radiologists correctly diagnosed otosclerosis in only 3 of 47 images (6.4%). The number of correct diagnoses were significantly different when made by the neurotologist and the general radiologist (𝜒2 = 25.14, P < .001, McNemar test). Conclusion: The results of this study show that a radiologist without sufficient experience in the field of neurotology may have a low detection rate of otosclerosis in high-resolution computed tomography of the temporal bone, as is consistent with the literature. In the light of this study, it can be concluded that more experienced eyes (neuroradiologist, neorotologist) are required to diagnose otosclerosis in HRCT than a general radiologist. [ABSTRACT FROM AUTHOR]

Our study aims to illustrate the clinical picture of otosclerosis in patients and the effect of surgery on the bone conduction thresholds compared to audiometry tests before surgery. A retrospective study included 36 patients that fit the inclusion criteria based on the patient's files and Pure Tone Audiometry of the patients before and after surgery. The questionnaire used is attached at the end of the study. According to Our sample, 77.8% were females, and 22.2% were males. The youngest was 17 years old, the eldest was 61, and the mean age was 38.2 years old. Hearing loss was the most common symptom in 100% of patients, while tinnitus was found in 66.7% and vertigo in 11%. The Injury was bilateral in 72% of the cases. Before surgery, the mean air conduction threshold (ACT) was 54.7 dB, the mean value of the air–bone gap (ABG) was 38.3 dB, and the mean bone conduction threshold (BCT) was 16.1 dB. Meanwhile, after the surgery, the mean BCT was 18.2 dB. Otosclerosis is more common in middle-aged females. Most cases are bilateral. Two-thirds of the cases of hearing loss were associated with tinnitus, while only a few had vertigo. A slight increase was noticed in BCTs after surgeries, especially at 4000 Hz. Stapedectomy caused a noticeable decrease in the values of BCTs on the frequency 4000 Hz. Stapedotomy improved the BCTs after surgery by about 5.3 dB at 4000 Hz. [ABSTRACT FROM AUTHOR]

To report an adverse event after successful otosclerosis surgery: piston extrusion through the tympanic membrane, and its surgical solution. Four patients with a history of stapes surgery in context of otosclerosis presented with recurrent conductive hearing loss due to piston extrusion. Otoscopy, audiometric assessment and CT-imaging were conducted to assess the encountered conductive hearing loss and extrusion of the prosthesis. Revision stapes surgery was performed with interposition of cartilage between tympanic membrane and piston-loop. Pre- and postoperative audiometry and otoscopic evaluation. Revision surgery resulted in postoperative ABG within 15 dB. No recurrent extrusion was seen after the mentioned surgical procedure including use of cartilage graft. In case of piston extrusion (trans-tympanic membrane), revision stapes surgery with interposition of a cartilage layer between tympanic membrane and piston is advocated to prevent recurrence. [ABSTRACT FROM AUTHOR]

Introduction The early geneticist and psychiatrist Ernst Rüdin (1874–1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi era. His connections in the international eugenics network have played an important role in the history of eugenics.

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