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Background: The surgical treatment of otosclerosis consists of the replacement of the stapes using a piston., Aims/objectives: The objective of this study is to assess the audiometric results and quality of life (QOL) of patients who underwent surgery for otosclerosis by stapedectomy with fascia interposition (STIP) or by stapedotomy using CO 2 laser (SLaser) without fascia interposition., Material and Methods: Ninety-one patients operated on for otosclerosis by STIP (40 patients) and by SLaser (51 patients) were included. Audiometric results were graphically displayed using the Amsterdam Hearing Evaluation Plot and were compared to the Common Otology Database (COD) comprising 660 patients. The patients' QOL was assessed with an otological validated survey. The significance level was p  < .05., Results: There was no significant difference in hearing improvement between SLaser and STIP-operated patients. There was no significant difference between our results and that of COD. QOL was significantly improved (+3.5/10) postoperatively for both STIP and SLaser in both social and professional fields., Conclusions and Significance: By comparing QOL and hearing gain of STIP and SLaser, our results suggest that both surgical techniques are a safe and successful treatment for otosclerotic stapes fixation. Further studies aiming at comparing larger series may confirm and refine these results.

There are limited studies describing the surgical and hearing outcomes following endoscopic stapes surgeries, despite the burgeoning interest and excitement in endoscopic ear surgery. Current studies have demonstrated that endoscopic stapes surgery is safe and has similar audiologic outcomes when compared with microscopic stapes procedures. However, preliminary studies show decreased postoperative pain in endoscopic cases compared with microscopic controls. In regards to possible endoscopic advantages, these few studies demonstrate mixed results when comparing the need to remove the bony medial external auditory canal wall to improve visualization and access to the oval window niche., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Importance: Stapedectomy is an effective treatment option for patients with symptomatic otosclerosis. A common surgical technique today is laser stapedotomy, although the equipment required adds a significant cost to the procedure and may not be available in certain, particularly remote, centers. This study aimed to evaluate cold steel stapedectomy in a modern otology practice as a cost-effective and versatile alternative. Objective: The primary objective was to evaluate the efficacy and safety of cold steel stapedectomy. The secondary objectives included characterizing the prevalence of relevant computed tomography (CT) findings and evaluating other factors such as piston size. Design: A retrospective case series from April 2006 to November 2021. Setting: A single tertiary care hospital in Montreal, QC, Canada. Participants: Patients with suspected otosclerosis and no prior stapes surgery. Intervention: Cold steel primary stapedectomy. Main Outcome Measures: In primary analysis, change in pure tone thresholds, pure tone average (PTA), and complication rates were obtained. Secondary analysis measures included rates of relevant CT findings and change in PTA with piston size. Results: A total of 302 cases were included in the analysis. The average change in air conduction PTA was a decrease of 27 dB, with 91% (276/302) having over 10 dB of improvement. The air-bone gap was closed to within 10 dB in 82% (248/302) of cases and within 20 dB in 96% (290/302) of cases. Overclosure occurred in 19% of cases, while only 4% resulted in worsened PTA bone conduction thresholds. In secondary analysis, 74% of CT scans demonstrated radiologic otosclerosis. Other findings included suspected superior semicircular canal dehiscence in 1.8%. Conclusion: Cold steel stapedectomy was demonstrated to be a safe and effective technique, with audiometric results comparable to laser and drill studies in recent literature. It should be considered as a cost-effective and global health accessible alternative. Additionally, CT scans can provide valuable information in the pre-operative workup. [ABSTRACT FROM AUTHOR]

Purpose: To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser. Methods: Retrospective observational study, which included patients treated with primary stapes surgery performed between January 2009 and January 2020. Three audiometric measurements (PTA, GAP and SDS) were evaluated as main results, evaluated by analysis of covariance (controlling the preoperative value). Intraoperative and postoperative complications were also analyzed. Outcomes were measured 6 months (± 1 month) after surgery. Results: 153 cases were included, 97 operated with conventional technique and 56 with laser technique. Postoperative GAP ≤ 10 dB was obtained in 85.6% of the total sample, 82.5% in the conventional technique and 91.1% in the laser technique. Analysis of covariance showed no significant differences in the three surgery outcomes between the two groups (PTA, p = 0.277; GAP, p = 0.509 and SDS, p = 0.530). Regarding surgical complications, sensorineural damage was higher in the conventional technique group (p = 0.05). On the other hand, there were four cases of facial paresis, all in the laser group, three of them with the 980 nm laser. Conclusions: Stapedotomy offered a high percentage of hearing success in the two groups studied. There were no significant differences in audiometric result, but there was a differential presentation of complications, being more frequent sensorineural hearing loss in the conventional technique group and facial paresis in the laser group. [ABSTRACT FROM AUTHOR]

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]

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]

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]

Introduction: Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results. Objective: The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy. Materials and Methods: Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy. Results: The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years). Conclusions: The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure. [ABSTRACT FROM AUTHOR]

Stapedotomy is a common treatment for conductive hearing loss in otosclerosis patients. Results of stapedotomy were assessed in terms of hearing improvement and risk of complications. Potential prognostic factors affecting outcomes were identified. Retrospectively, 93 stapedotomies were evaluated. The primary outcome was hearing improvement based on postoperative ABG ≤10 dB, Belfast rule of thumb, and AC gain ≥20 dB. Secondary outcomes were postoperative complications. Additionally, prognostic factors potentially affecting outcomes were analyzed (age, gender, comorbidity, preoperative audiometry, tinnitus, or vertigo). A mean ABG of ≤10 dB was achieved in 59%. According to the Belfast rule of thumb, 75% achieved interaural symmetry within ≤15 dB and/or a mean AC4 of ≤30 dB. A gain in AC4 of ≥20 dB was achieved in 57% of primary surgeries. The larger the preoperative ABG, the better hearing after surgery. There was no significant difference in hearing improvement at early and late follow-ups. Transient vertigo was the most common complaint (37%). Taste disturbances were the most frequent permanent complication (14%). Stapedotomy gave good audible improvement with a low risk of complications. Preoperative ABG was the only prognostic factor affecting the hearing outcome. Only one follow-up 6–12 months seems relevant. 背景：镫骨切开术是耳硬化症患者传导性听力损失的常见治疗方法。 目的：根据听力改善和并发症风险评估镫骨切开术的结果。 确定影响结果的潜在预后因素。 材料和方法：回顾性评估了 93 例镫骨切除术。 主要结果是听力改善, 基于术后 ABG ≤10dB、贝尔法斯特经验法则和 AC 增益 ≥20dB。次要结果是术后并发症。 此外, 分析了可能影响结果的预后因素（年龄、性别、合并症、术前听力检查、耳鸣或眩晕）。 结果：59% 的患者取得平均 ABG ≤10dB。 根据贝尔法斯特经验法则, 75% 的患者实现 ≤15dB 以内的耳间对称性和/或平均 AC4≤30dB。 57% 的初次手术实现AC4 的增益≥20dB 。 术前ABG越大, 术后听力越好。早期和晚期随访时的听力改善没有显著差异。 短暂的眩晕是最常见的主诉（37%）。 味觉障碍是最常见的永久性并发症（14%）。 结论和意义：镫骨切开术带来了良好的听觉改善, 且并发症风险较低。 术前 ABG 是影响听力结果的唯一预后因素。 仅一次6-12 个月的随访似乎是相关的。 [ABSTRACT FROM AUTHOR]

Although many advantages of endoscopic stapes surgery have been reported, there is little objective data on whether it provides better visualization than the microscopic approach. To evaluate and compare audiological results, external auditory canal wall removal area, and adverse event rates between endoscopic and microscopic stapes surgery. Data from patients who received stapedotomy were collected. Pre and postoperative audiometry, procedure-related parameters, and adverse events were analyzed in conventional microscopic and endoscopic groups. There were no differences in procedure time or postoperative hearing between the endoscopic and microscopic surgery groups. The mean procedure times were 87.3 ± 18.9 min in the endoscopic group and 79.9 ± 23.5 min in the microscopic group. The mean postoperative air-bone gaps were 10.9 ± 8.3 dB in the endoscopic group and 10.5 ± 7.8 dB in the microscopic group. There were no differences in the rate of sensorineural hearing loss, postoperative pain, facial palsy, vertigo, or dysgeusia between the two groups. The bony removal area of the posterosuperior external auditory canal wall measured by two observers was significantly less in the endoscopic group than in the microscopic group. Endoscopic stapedotomy needed less external auditory canal wall removal and showed similar audiological outcomes to microscopic stapedotomy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to investigate hearing outcomes in stapes revision surgery with regard to the type of clinic (university clinic or county clinic). Furthermore, the aim was to investigate the risk of complications with a focus on tinnitus, hearing deterioration, and taste disturbance 1 year after surgery. Methods: The study is based on data from the Swedish Quality Register for Otosclerosis Surgery (SQOS). Two study protocols were completed by the surgeon, and a questionnaire was distributed to the patients 1 year after surgery. A total of 156 revisions were available for analysis with both preoperative and postoperative audiometry data. Results: Seventy-five percent of the patients reported better to much better hearing 1 year after revision surgery. An air bone gap ≤ 20 dB postoperatively was seen in 77% of the patients. Four percent had hearing deterioration ≥ 20 dB PTA4 AC. Eleven percent had worsened or newly developed tinnitus, 5% had taste disturbance, and 3% had dizziness 1 year after surgery. Preoperative and postoperative hearing did not differ between patients operated on in university vs. county clinics. Conclusions: Revision surgery in otosclerosis is a challenge for otologists, but no differences in hearing outcomes between university and county clinics were found in this nationwide study. The risk of hearing deterioration and deafness is higher than in primary stapes surgery, and revision surgery should be recommended primarily in cases with a large air–bone gap and moderate to severe preoperative hearing loss. [ABSTRACT FROM AUTHOR]

The primary goal of the present study was to compare the pre- and post-stapedotomy elicitation and waveform characteristics of both air- and bone-conduction (AC-, BC-) cervical vestibular evoked myogenic potentials (cVEMPs) through an individualized approach. A possible association between audiological characteristics, such as AC- and BC- pure tone audiometry thresholds and air-bone gap and the production of cVEMPs before and after stapedotomy was also investigated. Twenty-five ears were subjected to full audiological evaluation as well as AC- and BC-cVEMPs pre- and post-stapedotomy. Four subgroups were studied; consistently present/absent, post-operatively disappeared and restored cVEMPs. Post-stapedotomy changes in cVEMP elicitability did not reach significance for either AC-cVEMP (OR = 5.41, 95% CI 0.88–33.36, P = 0.06) or BC-cVEMP (OR = 2.40, 95% CI 0.42–13.60, P = 0.3). Normal or abnormal AC-cVEMPs were equally subject to post-operative changes (OR = 1.95, 95% CI 0.32–12.01, P = 0.5), as were BC-cVEMPs (OR = 3.75, 95% CI 0.66–21.25, P = 0.1). Neither the audiological characteristics nor the surgical outcome, in terms of ABG results, were relevant to the presence or absence of AC- and BC-cVEMPs before or after stapedotomy. The presumed changes brought to the sacculus by stapedotomy are minor and beyond the diagnostic abilities of either AC-cVEMPs or BC-cVEMPs, both in terms of cVEMPs elicitability and waveform characteristics. In individual cases, however, which may deserve further investigation, cVEMPs may reappear or disappear after stapedotomy probably following minor changes toward a lower or higher vestibular system resistance for pressure and sound transmission. [ABSTRACT FROM AUTHOR]

Introduction: The main determinant in deciding on stapes surgery in patients with otosclerosis is the degree of hearing loss, specifically the size of the preoperative air-bone gap (ABG). The debate over the minimum ABG centers on the risk-to-benefit ratio of stapes surgery in patients with small ABG (sABG). The aim of this study was to measure the audiological outcomes and self-assessed satisfaction in a group of otosclerosis patients with an sABG who underwent stapedotomy. Methods: There were 83 patients with preoperative sABG ≤25 dB HL (mean of 500, 1,000, 2,000, 4,000 Hz) included in this study. Audiometry was performed before surgery and 6 months and 12–36 months after surgery. Self-reported patient outcomes before and after surgery were collected using questionnaires. Results: At the 6-month follow-up, the ABG was closed within 10 dB in 63 (78.8%) cases. Preoperatively, tinnitus was present in 70% of patients, of which 66% reported that tinnitus was a moderate or severe problem. Postoperatively, 71% of patients experienced a significant reduction in tinnitus severity and 34% of them reported complete disappearance. The self-report outcomes relating to quality of life and hearing reflected a good level of satisfaction in most patients. Conclusion: The possibility of reducing bothersome tinnitus after stapes surgery, and thus improving the patient's quality of life, should be taken into account when making a decision on stapes surgery in these patients. [ABSTRACT FROM AUTHOR]

The surgical treatment of otosclerosis consists of the replacement of the stapes using a piston. The objective of this study is to assess the audiometric results and quality of life (QOL) of patients who underwent surgery for otosclerosis by stapedectomy with fascia interposition (STIP) or by stapedotomy using CO2 laser (SLaser) without fascia interposition. Ninety-one patients operated on for otosclerosis by STIP (40 patients) and by SLaser (51 patients) were included. Audiometric results were graphically displayed using the Amsterdam Hearing Evaluation Plot and were compared to the Common Otology Database (COD) comprising 660 patients. The patients' QOL was assessed with an otological validated survey. The significance level was p <.05. There was no significant difference in hearing improvement between SLaser and STIP-operated patients. There was no significant difference between our results and that of COD. QOL was significantly improved (+3.5/10) postoperatively for both STIP and SLaser in both social and professional fields. By comparing QOL and hearing gain of STIP and SLaser, our results suggest that both surgical techniques are a safe and successful treatment for otosclerotic stapes fixation. Further studies aiming at comparing larger series may confirm and refine these results. [ABSTRACT FROM AUTHOR]

Objectives: We describe our experience with long process incus (LPI) necrosis in revision stapedotomy and discuss the different management methods proposed in the literature to identify surgical techniques that can lead to satisfactory results over time. Methods: Twenty-two stapedotomy revisions, in 21 patients with the necrosis of the long process of the incus, are performed from 1997 to 2017. In cases of erosion or minimal necrosis of LPI, a new prosthesis of the same type or an angled prosthesis was applied higher on the residual incus stump. In cases of partial necrosis of LPI, a Donaldson type ventilation tube reshaped and placed on the residual incus stump to stabilize prosthesis, or glass ionomer bone cement was used. In cases of subtotal necrosis of LPI, a cup piston prosthesis in polycel was applied on incus residual stump. Pre- and postoperative (≥1 year) pure tone audiometry was performed for all cases. Air conduction threshold, bone conduction (BC) threshold, and air-bone gap (ABG) were documented according to the American Academy of Otolaryngology Head and Neck Surgery Committee of Hearing and Equilibrium guidelines. Results: At 1-year follow-up, postoperative ABG was reduced to ≤10 dB in 13 (59%) cases and ≤20 dB in 19 (86.4%) cases. The mean postoperative ABG significantly decreased in each group. There was no significant change in postoperative BC thresholds, and there were no cases with postoperative SNHL. Conclusion: Excellent functional results can also be achieved in cases of long incus process necrosis. The choice of technique should be considered according to the degree of necrosis. Piston replacement with the same type or angled type prosthesis, in cases of erosion or minimal LPI necrosis, and modified Donaldson type ventilation tube, in cases of partial LPI necrosis, provided excellent hearing results. [ABSTRACT FROM AUTHOR]

Objective: This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO). Data sources: A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of science and Cochrane Library was conducted in June 2021 for articles in the literature till this year. Study selection: Studies are published in English language, conducted on human subjects, concerned with comparison of CI and stapes surgery in the management of FAO, not Laboratory study and not Opinion study. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). Data extraction: Twenty-six studies were included with 334 patients in CI group and 241 patients in stapes surgery group. Comparison between both groups was done in terms of postoperative complications, audiological outcomes, rete of revision surgery and patients' satisfaction rate. Results: Postoperative complications rate was significantly lower in CI (13.6%) than stapes surgery (18.6%). CI had a significantly lower rate of revision surgery (8.1%) than stapes surgery (16.4%). CI had a better mean for pure tone average (29.1 dB) than stapedectomy (52.3 dB) while stapes surgery had a higher mean for recognition of monosyllables and disyllables than CI. CI had significantly higher satisfaction rate than stapes surgery. Conclusion: Both Stapes surgery and CI are reliable treatment options for FAO with close success rates. Statistics of CI are greater than stapes surgery and CI has a consistent improvement in audiometric outcomes in comparison to stapes surgery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the long-term hearing outcomes in stapedotomy surgery using skeeter oto-drill and to assess safety in difficult situations. Method: A retrospective study was conducted with 944 patients who underwent 1007 stapedotomy procedures over 16 years, performed by a single surgeon using a trans-canal approach and a self-retaining ear canal retractor. Hearing thresholds were calculated over four frequencies. Air–bone conduction hearing thresholds were obtained at 1, 5 and 10 years post-operatively and compared to the pre-operative records. Results: Out of 1007 operated ears with one year follow up, 98.61 per cent of cases showed a negligible air–bone gap of equal to or less than 5 dB, 1.19 per cent of cases showed an air–bone gap equal to or more than 5 dB but less than 10 dB, and only 0.2 per cent of cases showed an air–bone gap of more than 10 dB. Conclusion: In this study, using skeeter drill with a 0.6 mm diamond burr to make the fenestra was constant in all the cases and one of the safest techniques, showing persistent long-term hearing results. [ABSTRACT FROM AUTHOR]

BACKGROUND: The study aims to investigate the effect of stapedotomy on audiology measurements and the disease-specific health-related quality of life for patients with otosclerosis using the Danish Stapesplasty Outcome Test-25 as a quality of life measuring tool. METHODS: In this study, 50 patients who had undergone stapedotomy at our department between September 2017 and December 2020 were included. Data collection was performed by audiometric testing (pure tone and speech audiometry) in the pre- and postoperative settings. Health-related quality of life was assessed pre- and postoperatively in 30 patients using the validated Danish Stapesplasty Outcome Test-25. RESULTS: The mean improvement in air conduction thresholds was 27.7 dB and the mean improvement in air-bone gap was 21.8 dB. Healthrelated quality of life improved significantly after stapes surgery in all subscores of the Stapesplasty Outcome Test-25 (hearing, mental condition, social restriction, and general), except for "tinnitus." The improvement in the audiometric data correlated significantly with the improvement in "total score" and "hearing function" but not with "tinnitus," "social restrictions," and "mental condition." CONCLUSION: Stapedotomy leads to significant improvement in hearing and health-related quality of life. The Stapesplasty Outcome Test-25 can be used as a valuable supplement to the hearing test by assessing health-related quality of life. [ABSTRACT FROM AUTHOR]

Otosclerosis is characterized by a bony remodeling process that ends up with stapes fixation. The hearing impairment can be recovered by surgery by replacing the stapes superstructure. Due to the surgical management of the vestibule, the vestibular examination could provide an insight into the correlation between this kind of surgery and vestibular changes. To evaluate the impact of the stapedotomy on the inner ear. We evaluated pure tone audiometry and the presence of vestibular evoked myogenic potentials (VEMPs) in 41 patients with otosclerosis before and after the stapedotomy operation. Air conduction (Ac)-VEMPs were present in 18 cases preoperatively and 31 cases postoperatively. Bone conduction (Bc)-VEMPs were present in 23 cases preoperatively and 33 cases postoperatively. ABG was closed to less than 20 dB in all cases after the operation The preoperative Bc-VEMPS had an outstanding capability to predict the type of hearing loss. The postoperative absence of VEMPS despite the closure of ABG indicated the impact of otosclerosis on the saccular cells. The use of Thulium Laser in stapedotomy didn't affect significantly the saccular cells. Integrated use of audiometry and VEMPs was effective to evaluate the changes associated with otosclerosis and the stapedotomy operation. [ABSTRACT FROM AUTHOR]

Thulium laser use in stapedotomy surgery is usually associated with many doubts regarding the thermal effect on the vestibular area and the production of acoustic shock waves, which may result in permanent complications. We aimed to evaluate the efficacy and safety of the Thulium laser use in stapedotomy and its long-term effects on the clinical and audiological results. It was a retrospective randomized case-series study. We included 148 otosclerosis patients. They were divided randomly into two groups; group A (multiple shots) included 62 patients and group B (one shot with a manual perforator) included 86 patients. There was a statistically significant improvement of the ABG in both groups. ABG closure (<10 dB) occurred in 87.1% of patients in group A, and 89.5% of patients in group B. Intraoperative complications were more in group B (p-value = 0.038). The postoperative complications were more in group A (p-value =.017). According to our experience on a relatively large number of cases, the Thulium laser is a safe tool to be used in stapedotomy either in multiple shots or one shot with a manual perforator. It improved functional hearing efficiently without showing signs of inner ear impairment. [ABSTRACT FROM AUTHOR]

Objectives: To describe audiologic outcomes following hydroxyapatite bone cement fixation of stapedotomy prostheses. Methods: A retrospective case review at a tertiary neurotology referral center was performed of patients undergoing primary or revision stapedotomy between 2010 and 2017. Patients with hydroxyapatite bone cement fixation of stapes prostheses were assessed. Pre- and postoperative hearing was compared, consisting of air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Short and long-term outcomes were assessed. Results: Forty-six patients with otosclerosis underwent stapedotomy with bone cement fixation: 21 primary cases and 25 revision cases, with an average follow-up time of 17 months. Mean AC PTA was 56 dB preoperatively, and 34 dB postoperatively (P <.0001), while the ABG improved on average from 27 dB to 9 dB (P <.0001). There was no significant difference in postoperative ABG between primary and revision stapes surgery (6 dB vs 10 dB, P =.07). These results persisted through long-term follow-up in a subgroup of patients with significantly longer follow-up time (mean 44 months). There was no significant change in BC PTA or word recognition scores. Three patients underwent subsequent revisions, one patient developed sensorineural hearing loss. Conclusion: Stapedotomy with bone cement fixation of the prosthesis provides excellent hearing outcomes in both primary and revision treatment of otosclerosis. Results are consistent and stable through long-term follow-up. The use of bone cement should be incorporated into the surgical armamentarium of the otologist for the prevention and treatment of loose-wire syndrome and incus necrosis. [ABSTRACT FROM AUTHOR]

Objective: This study was focused on the assessment of patient's improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis. Materials and Methods: This prospective clinical study was performed in a total of 156 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT & Head-Neck Surgery, Combined Military Hospital Dhaka between January 2013 to January 2019. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction & air conduction thresholds and the Air-Bone gap (ABG), were documented and analyzed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 83.97% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except 03, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 04 patients developed post-op severe vertigo which was self-limiting after six weeks. 01 patient developed transient facial weakness which was subsided over a time period of 03 months. Patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy. Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes. [ABSTRACT FROM AUTHOR]

Although stapedotomy is effective for patients with clinical otosclerosis, the time of hearing stabilization has not yet been consistent. To investigate the relationships between post-operative follow-up times, hearing outcomes, and threshold shift after stapedotomy. Fifty-five patients with clinical otosclerosis that underwent stapedotomy were retrospectively studied. Pure tone audiometry tests were conducted within the first month (short-term) and within 1 year (mid-term) postoperatively. Data were analyzed for two rounds of audiometry tests at different postoperative follow-up times. Air conduction (AC) and bone conduction (BC) were significantly correlated with preoperative hearing levels (p<.01). AC, BC, and air bone gap (ABG) significantly improved at the short-term (p<.001) and continued to improve at the mid-term (p<.01). The success rate of surgery increased from 87% at short-term to 98% at mid-term. Less than 1/3 of cases encountered BC deterioration at short-term, whereas most improved at mid-term. Hearing results showed a trend of improvement between short-term and mid-term follow-ups after stapedotomy. AC, ABG, and success rate displayed significant improvement several months postoperatively. BC deterioration occurred in less than 30% of patients at short-term. The recovery of BC at 4 kHz was later than that of low frequencies. [ABSTRACT FROM AUTHOR]

Introduction: Stapes surgery is a safe procedure, with favourable hearing outcome. The objective of the study is to assess the long-term hearing results, addressing the bone conduction (BC) decay and the need for hearing aids in otosclerosis patients.Methods: We enrolled patients who underwent stapes surgery by means of stapedectomy or stapedotomy between 1991 and 2001. All enrolled patients underwent pure-tone audiometry (PTA) between September 2017 and June 2018. A set of questions was administered to record the prevalence of subjective symptoms and the need for hearing aids.Results: Seventy patients were enrolled for a long-term evaluation; 37 patients underwent bilateral surgery; therefore, 107 ears were included in the analysis. The average follow-up period was 22 years. No statistically significant difference was found between early and late post-operative air conduction (AC) PTA (41 vs. 49 dB; p > 0.05) nor between early and late post-operative BC-PTA (29 vs. 37 dB; p > 0.05). A significant difference was observed for AC at 8 kHz (65 vs. 78 dB; p < 0.05) and BC at 2 and 4 kHz (28 vs. 40 dB and 45 vs. 58 dB, respectively; p < 0.05).Conclusions: This is, to our knowledge, the longest mean follow-up time in the literature. A mild decrease in both AC and BC threshold can be expected and the sensorineural decay is more pronounced on the high frequencies. The subjective hearing symptoms and overall sound perception are satisfactory. [ABSTRACT FROM AUTHOR]

Eighteen patients underwent simultaneous bilateral stapes surgery in 2003–2006. We evaluated the long-term outcomes in this patient group, and assessed their hearing in noise and binaural hearing. Fifteen patients returned questionnaires concerning their hearing, taste function, and balance. Thirteen patients underwent pure-tone and speech audiogram, Finnish matrix sentence test, video head impulse test, and clinical examination on average 13 years after surgery. We found no significant difference in air- and bone conduction pure-tone average, speech audiometry, and the air-bone gap between the 1-year and the late postoperative visits. One patient had bilaterally a partial loss of the vestibulo-ocular reflex of unknown cause. The hearing results 13 years after simultaneous bilateral stapes surgery remained good without any significant delayed complications. Simultaneous bilateral stapes surgery is a viable treatment option in selected patients with otosclerosis. [ABSTRACT FROM AUTHOR]

Objective: This is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center.Methods: This study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003-16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and >12 months). Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed.Results: In short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p < 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p < 0.05).Conclusion: Stapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of perceived sound after stapedotomy over a 1-year follow-up period focussing on incidence of dysacusis, particularly distorted sound perception (DSP). DSP was assessed by (i) determination of the frequencies and hearing level that such perceptions are elicited by pure tones (pure-tone-evoked distorted sound perception, PTE-DSP), a novel psychoacoustic measurement introduced in this paper, and (ii) assessment of patient-reported occurrence of DSP using the Amsterdam Post Operative Sound Evaluation (APOSE) questionnaire (APOSE-DSP). Design: Prospective study. Study sample: Patients (n = 23) with otosclerosis undergoing stapedotomy. Results: An air-bone gap of <20 dB was achieved in 100% of the patients. Three weeks postoperatively, 48% of the patients reported measured PTE-DSP and 39% of the patients experienced APOSE-DSP. The PTE-DSP significantly decreased during the 1-year follow-up period (p = 0.03). Postoperatively, APOSE-DSP was associated with a smaller benefit (improvement in air conduction; p = 0.03), yet, a lower bone conduction pure-tone average was associated with PTE-DSP (p = 0.006). Conclusions: DSP after stapedotomy is associated with a smaller benefit 3 months after stapedotomy. DSP commonly occur after stapedotomy, but decrease over time. This is important information to be included in patient counselling before stapedotomy. [ABSTRACT FROM AUTHOR]

Background. A stapedectomy or stapedotomy is known as the best treatment option for patients with otosclerosis. Otosclerosis is a primary disease of the bony labyrinth capsule, which is characterized by one or more localized foci, where bone deposition occurs repeatedly. The best and most effective treatment option is a stapedectomy or stapedotomy. Objectives. The present study evaluated the short-term hearing results in patients with otosclerosis after primary stapes surgery. Material and methods. In this retrospective study, the short-term hearing results of all patients with otosclerosis after a primary stapedotomy admitted to the Ahvaz Emam hospital from 2007 to 2017 was evaluated. Improvement in hearing was evaluated according to the pre- and post-audiometry results. Air Conduction (AC), Bone Conduction (BC) and Air-Bone Gap (ABG) thresholds were recorded at 500, 1 000, 2 000 and 4 000 Hz. SPSS software (Version 22.0) was used for statistical analysis. Results. Of the 413 cases, 231 (55.93%) and 182 (44.07%) were females and males, respectively. The mean age of patients was 39.06 ± 11.29 years. The disease in 131 (31.72%) was bilateral. The mean ABG in 341 patients (82.63%) ≤ 10 dB and in 52 patients (12.47%) was 10-20 dB. Conclusions. The results of the study showed that a primary stapedotomy is a successful and effective way to improve short-term hearing results in adults with otosclerosis. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the audiological variables and to investigate the factors affecting hearing improvement in patients who underwent stapedotomy with the diagnosis of otosclerosis. Methods: The data of 114 patients who had middle ear exploration were retrospectively reviewed. Air conduction thresholds between 250-6000 Hz and bone conduction thresholds between 500-4000 Hz were examined in pure tone audiometry. Postoperative air-bone gap (ABG), change in ABG, and change in bone conduction threshold at high frequency were primarily examined. The results of different piston diameters were compared. Results: Eighty-three patients with stapedial footplate fixation were included in the study. While post-operative air conduction thresholds decreased significantly at all frequencies, bone conduction thresholds decreased significantly only at 2000 Hz (p=0.001). The most notable gain in ABG was obtained at 500 Hz. The post-operative air conduction pure tone average was significantly higher in patients with 0.6 mm diameter prosthesis. Postoperative mean ABG and ABG values at 2000 and 4000 Hz were found to be significantly lower in patients with 0.8 mm diameter prosthesis (p<0.05). The change in ABG at 2000 Hz was significantly lower in patients with 0.6 mm diameter prosthesis (p=0.029). The mean change in bone conduction thresholds at high frequencies was positive in 58 patients (70%) and negative in 25 patients (30%). There was no difference between different piston diameters regarding bone thresholds at high frequencies. Conclusion: Improvement was achieved at all frequencies in air conduction thresholds following stapedotomy. In our study, it was found that the lower the pre-operative bone conduction thresholds were, the more the improvement in ABG. A significant advantage was achieved at 2000 and 4000 Hz frequencies in patients with 0.8 mm piston diameter compared to 0.6 mm piston diameter. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally.Study Design: A retrospective cohort study of prospectively gathered data in a tertiary referral center.Methods: The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated.Results: Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%).Conclusions: Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up.Level Of Evidence: 2b. Laryngoscope, 128:2390-2396, 2018. [ABSTRACT FROM AUTHOR]

Purpose: Analysis of the differences in inner ear admittance achieved by a large fenestra in comparison with a small fenestra and its effect on bone conduction in stapes surgery. Materials and methods: Description of an interesting case of bilateral otosclerosis with an atypical and symmetrical behaviour of bone conduction, treated with a stapedotomy on the right ear some years before, and recently submitted to stapedectomy on the left year. Results: Concerning the left side, the first complete audiometry was made 15 days after stapedectomy and confirmed a bone conduction improvement, that subsequently increased until almost to the normality 42 days after surgery. The mean postoperative bone conduction difference was 13 dB considering all frequencies; when considering the frequencies between 500 and 2000 Hz the mean difference raised to 20 dB. Conclusions: The reported case, in which the stapedectomy was not scheduled as the first option, but derived from a particular intraoperative situation thus resulting in an almost obligatory choice, permits some interesting conceptual considerations. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of otosclerosis requires considerable experience of the otosurgeon, especially in advanced cases or in an ear with an unusually narrow external auditory canal, a narrow niche of the round window, a significantly thickened stapes footplate, or an exposed or hanging facial nerve. Case involving subsequent reoperations by different surgeons can be particularly difficult. Collective knowledge of treatment failures during otosclerosis reoperation, as set out in the literature, does not list the difficulties encountered, fails to assess most causes of failure, and does not describe remedies and corrective techniques. Material and methods: The course of treatment followed by a 55-year-old complaining of progressive, bilateral, mixed hearing loss due to otosclerosis is described. The patient's treatment consisted of stapes mobilization, followed by stapedotomy and restapedotomy of the right ear, and stapetodomy of the left ear. Results: There was short-term improvement of hearing after mobilization of the stapes, but its subsequent deterioration, with elevation of both the air- and bone-conduction thresholds in the right ear, were indications for reoperation and stapedotomy. Short-term improvement in hearing was achieved after the operation, followed by rapid hearing loss. Due to this and growing balance disorders after nearly a year, a restapedotomy was performed with complete closure of the air-bone gap. Then, due to hearing deterioration in the left ear, a successful stapedotomy was performed in this ear. Conclusion: Revision operations in otosclerosis require a lot of experience of the otosurgeon due to the many reasons for failure, particularly when the first surgery was performed elsewhere. An air-bone gap, severe tinnitus, and balance disorders are indications for reoperation by an experienced otosurgeon, as common causes of failure are postoperative adhesions and subsequent stapes immobilization. [ABSTRACT FROM AUTHOR]

Otosclerosis is most often diagnosed in adults, especially women. It is much less common in children and even rarer in boys. The aim of this paper is to present the case history and results of surgical treatment of a 5-year-old boy with bilateral conductive hearing loss and tinnitus. Results of surgical treatment show mean air-bone closure of 25 dB and cessation of tinnitus. Surgical treatment for otosclerosis is recommended regardless of the patient's age. Additional motivations for surgical intervention in children are: severe progressive hearing loss, tinnitus, and rising bone-conduction threshold. [ABSTRACT FROM AUTHOR]

Conclusion: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes. Objective: To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis. Methods: A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air–bone gaps (ABG) were calculated from pre-operative and post-operative audiograms. Results: Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3). [ABSTRACT FROM AUTHOR]

Objective: To compare endoscope-assisted microdrill stapedotomy with the conventional technique. Material and Method: A retrospective comparative study of 37 otosclerosis stapes fixation surgeries performed with the conventional technique or the endoscope-assisted microdrill stapedotomy were evaluated. Audiometric data and intraoperative and postoperative complications were recorded. Results: The mean operating time was 128 min in the endoscopic group and 132 min in the conventional group, (p = 0.72). Residual air-bone gaps of ≤10 decibels were obtained in 83.3% and 47.4% of the patients in the endoscopic group and the conventional group, respectively, (p = 0.04). No footplate fractures and incidences of postoperative vertigo and chorda tympani nerve injuries were found in the endoscopic group. Postoperative vertigo was found in 31.6% of the conventional group, and 26.3% of the patients in the conventional group had undergone an endaural surgical approach owing to inadequate exposure under the microscope. Conclusion: An endoscope-assisted microdrill stapedotomy was associated with significantly better hearing results, a lower postoperative vertigo rate, and fewer footplate fractures and chorda tympani nerve injuries than the conventional technique. [ABSTRACT FROM AUTHOR]

The use of 'one-shot' CO laser technique for a primary small-fenestra stapedotomy is well established, but few papers report the long-term functional results. We retrospectively reviewed medical records of 198 patients, treated for otosclerosis from January 2008 to December 2011, at the Department of Head and Neck Surgery, Catholic University of Rome. Statistical comparison between audiological thresholds obtained 24 h preoperatively, at early (4 weeks) and late postoperative examinations (mean time 45 months), was performed. Comparison of preoperative vs both early and late postoperative ACPTA showed a statistically significant difference (respectively 55 vs 33 and 31 dB; p < 0.001). No statistical difference was observed between preoperative, early and late postoperative BCPTA (respectively 23 vs 23 and 22 dB; p > 0.05). Both early and late postoperative ABG improved significantly compared to the preoperative one (respectively 10 and 9 vs 32 dB; p < 0.001). No statistical difference was found in comparison of early vs late postoperative ACPTA (respectively 33 vs 31 dB; p > 0.05), early vs late postoperative ABG (respectively 10 vs 9 dB; p > 0.05) and early vs late ABG gain (respectively 22 vs 23 dB; p > 0.05). No subjects developed postoperative complications requiring revision surgery or late deterioration of hearing threshold. The analysis of our data suggests that 'one-shot' CO laser stapedotomy is an effective and safe procedure: it allows a rapid stapedotomy without damages for the inner ear and optimal functional results that remain stable during the years. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is characterized by bony deposits in the otic capsule, resulting in stapes fixation and progressive hearing loss. It can be treated effectively by surgically removing (part of) the stapes and replacing it with a prosthesis. Increasingly, stapes surgery is performed as a day-case procedure. The major drive towards day-case surgery has been out of economic considerations. However, it is also increasingly an explicit patient request and leads to shorter waiting times for surgery, a reduced risk of infection and most likely positively influences the patient's quality of life as a result of rapid discharge and rehabilitation. Even though stapes surgery seems well suited to a day-case approach, given the low complication rates and early recovery, evidence is scarce and of low quality. Methods and design: A single-center unblinded randomized controlled trial was designed to (primarily) investigate the effect of hearing outcomes of day-case stapes surgery compared to inpatient stapes surgery and (secondarily) investigate the effect of both methods on quality of life, tinnitus, vertigo and cost-effectiveness. One hundred and twelve adult otosclerosis patients who are eligible for stapes surgery will be randomly assigned to either the day-case or inpatient treatment group. The primary and secondary outcome measures will be assessed using pure-tone audiometry (at approximately 2 months and 1 year follow-up), questionnaires (at 3 months and 1 year follow-up) and costs diaries (weekly the first month after which once a month until 1 year follow-up). Discussion/conclusion: This trial allows for a comparison between day-case and inpatient stapes surgery to investigate the hypothesis that day-case stapes surgery is associated with a higher quality of life and higher cost-effectiveness, while maintaining equal hearing results, compared to inpatient stapes surgery. [ABSTRACT FROM AUTHOR]

Conclusion: Current guidelines recommend reporting short-term results of > 12 months after treatment of conductive hearing loss. This study suggests that short-term hearing results after stapedotomy recorded at the 3-month follow-up are without loss of vital information compared with data from the currently recommended > 12-month follow-up. The use of 3-month data in reporting outcome could reduce the bias inherent to the loss to follow-up at 12 months. Objective: To investigate the stability of short-term postoperative hearing after stapedotomy for otosclerosis. Methods: This was a prospective database study; 371 cases with otosclerosis were registered in the database between August 2004 and June 2013. We included the 166 primary cases and 37 revision cases that had attended both follow-ups. Results: The mean changes in postoperative hearing thresholds between the 3-month and 12-month follow-up in both primary and revision cases were minimal and clinically insignificant. In all, 3-5% of primary cases and 14-16% of revision cases experienced a change of ≥ 10 dB for the worse of one or more parameters between follow-ups. Results were also stable when considering a range of traditional success criteria. Other complications following surgery were infrequent and typically resolved long term. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aims of this study were to review the causes of stapes fixation in children undergoing stapes surgery and to analyze the results of stapes surgery in children in the short term, at 1 year, and over the long term. Methods: The medical records of 18 children (28 ears) who had undergone stapes surgery between January 1999 and December 2012 were retrospectively reviewed. The medical history, computed tomography results, intraoperative findings, video clips, and hearing outcomes of all patients were reported. Results: The mean age of patients was 11.1 years (range, 5.9–15.3 years). Congenital stapes fixation (22/28 ears, 79%) and juvenile otosclerosis (6/28 ears, 21%) were responsible for all cases of stapes fixation. Intraoperatively, abnormal facial nerves that were downwardly displaced over the stapes footplate were noted in four ears. Incudostapedotomy was performed in 24 ears, malleostapedotomy in three, and partial stapedectomy in one. The early postoperative audiometric outcome was favorable in 21 ears (87.5%). There was no significant difference between early postoperative (87.5%), 1 year postoperative (91%), and long term (92.3%) favorable audiometric results. There was no significant difference in the postoperative hearing results between patients with congenital stapes fixation and juvenile otosclerosis. Conclusion: Congenital stapes fixation was diagnosed in 22 (79%) ears and juvenile otosclerosis in six (21%) ears from a series of 28 ears that were operated on for stapes fixation. Facial nerve anomalies were found in four of 22 ears (18%) that had congenital stapes fixation. There was no difference in the postoperative hearing results between patients with congenital stapes fixation and juvenile otosclerosis. Regardless of the cause of stapes fixation, stapedotomy is a safe and effective procedure for managing the condition. [Copyright &y& Elsevier]

Developments in surgical technique and, more importantly, the use of increasingly sophisticated biocompatible prostheses have meant that good results can be achieved for otosclerosis sufferers in terms of restored hearing and very little postsurgical discomfort. We set out to assess whether the diameter of the prostheses used for stapedotomy (platinum piston/polytetrafluoroethylene, i.e. Teflon) has any effect on surgical outcome. Two groups of otosclerotic patients were selected, and these underwent stapedotomy surgery during the second phase of the disease. A piston-Teflon type prosthesis was used, 5.50 mm in terms of length but of different diameters (group A: 0.4 mm; group B: 0.6 mm). All the patients underwent the same pure-tone audiometry test before surgery, and then at 1 week and 1 month after surgery, to assess function. We compared air conduction after surgery with bone conduction before surgery. The data collected was analysed using the χ2 (p < 0.05) test. This analysis showed that the results obtained with a 0.4-mm prosthesis or a 0.6-mm prosthesis are almost identical. There was no statistically significant difference in terms of hearing results when comparing either average tonal threshold or when analysing audiometric data frequency by frequency. It can be concluded, therefore, that in stapedotomy surgery, functional recovery is not affected by the diameter of the prosthesis used. A smaller diameter prosthesis is, however, the one of choice when the facial nerve is prominent or the oval window particularly narrow. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective:This study aimed to use a new otological technique, malleus relocation, to solve the problems of ossicular reconstruction undertaken during revision stapes surgery for incus necrosis.Study design:Prospective study of 12 patients undergoing revision stapedectomy for incus necrosis, in the otolaryngology department of Mansoura University, Egypt.Patients and methods:Twelve patients underwent ossiculoplasty between June 2004 and June 2007, as part of revision surgery for otosclerosis with incus necrosis. All patients underwent ossiculoplasty using the malleus relocation technique. Ossiculoplasty used the patient's own, necrosed incus between the relocated malleus and the footplate.Results:Post-operative air–bone gap closure to within 10 dB was achieved in seven patients (58.3 per cent). An air–bone gap of less than 20 dB was obtained in 10 patients (83.3 per cent). Deterioration of bone conduction by 10 dB occurred in one case. No patients were left with a ‘dead ear’. Patients’ hearing was stable throughout the follow-up period (range six to 40 months; mean ± standard deviation 23.5 ± 12.8 months).Conclusion:These findings indicate that malleus relocation, performed during revision stapes surgery, is a safe and efficient technique for the treatment of incus necrosis. [ABSTRACT FROM PUBLISHER]

Objectives: We describe the audiometric results after stapes surgery in a consecutive series of patients with isolated stapes footplate ankylosis. Methods: We performed a retrospective analysis of charts from 1986 to 2001 in a tertiary referral center, focusing on audiometric results. Results: A total of 28 patients (39 ears) underwent stapedotomy or stapedectomy, and 5 patients (5 ears) had a syndromal diagnosis. Overall, we observed a mean gain in air conduction threshold of 21 dB (from 46 to 25 dB) and a mean postoperative air-bone gap of 14 dB (mean preoperative air bone gap, 36 dB). The postoperative air-bone gap was 10 dB or less in 46% of cases, in agreement with results reported in the literature. Moreover, the audiometric results remained stable. In the group of ears with a syndrome, the mean gain in air conduction threshold was only 12 dB (range,-13.8 to 32.5 dB). which was a worse outcome than that in the nonsyndromic ears. Conclusions: Surgery for isolated congenital stapes footplate ankylosis provides satisfactory audiometric outcomes. The postoperative air-bone gap was 10 dB or less in 18 of the 39 ears (46%) and 20 dB or less in 29 of the 39 ears (74%). Most ears had some sensorineural impairment (10 to 20 dB), which influenced the final hearing level after surgery. Preoperative assessment is mandatory to search for syndromal diagnoses, which might be important for patient counseling and prognosis. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aim of this study was to identify the causes and the audiometric results of revision surgery following stapedotomies and stapedectomies. Patients and methods: We retrospectively reviewed a series of 89 revisions after surgery for otosclerosis between 1993 and 2008. Intraoperative findings, causes of failure, and pre- and postoperative audiometric results were noted retrospectively. Results: The leading causes of failure found intraoperatively included dislocated prosthesis and necrosis of the long process of the incus. The average postoperative air–bone gap was 13dB. Closure of the air–bone gap to within 10dB was achieved in 52% of patients. Conclusion: Stapes revisions had less satisfactory results compared with primary procedures in this series. However, certain precautions during initial surgery should decrease the number of stapes surgery revisions. [ABSTRACT FROM AUTHOR]

Aims: We aimed to evaluate bilateral hearing function in patients undergoing primary unilateral stapedotomy, according to the 1995 American Academy of Otolaryngology, Head and Neck Surgery guidelines and the Glasgow benefit plot. We also aimed to analyse the effect of pre-operative hearing impairment type on post-stapedotomy hearing. Study design: Retrospective chart review. Methods: Medical records relating to 1369 stapedotomies performed by the senior author (JJH) from 1991 to 2006 were reviewed. Seven hundred and fifty-one patients undergoing primary unilateral stapedotomy were included. Hearing results for these patients were evaluated according to the criteria of the 1995 American Academy of Otolaryngology, Head and Neck Surgery Committee on Hearing and Equilibrium guidelines, and the Glasgow benefit plot. Subgroups of patients with pre-operative unilateral, bilateral symmetrical and bilateral asymmetrical hearing loss were separately analysed. Results: The most successful results, as regards the achievement of bilateral, socially serviceable hearing, were demonstrated in patients with unilateral hearing loss; 78 per cent of these patients had normal hearing post-operatively. Overall, patients' achievement of bilateral, socially serviceable hearing correlated highly with their type of pre-operative hearing impairment (r = 0.74). Normal post-operative hearing levels also correlated with pre-operative bone conduction (r = 0.61). Conclusion: This study represents the largest reported series of primary stapedotomy cases evaluated with the Glasgow benefit plot. Patients' bilateral post-operative hearing function depended on their type of pre-operative hearing impairment. Pre-operative bone conduction thresholds, corrected for Carhart's effect, were useful in predicting achievable post-operative air conduction. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present our experiences and results of stapedotomy performed with and without the piezoelectric device. Design: The article evaluates and compares the use of the piezoelectric device in performing primary stapedotomy in patients affected by otosclerosis with the traditional method of microdrilling. Setting: The study was conducted with 100 patients in the Department of Otolaryngology of the University of Genoa (Italy), between January 2007 and January 2008. Methods: A prospective, randomized, controlled trial was undertaken on 100 stapedotomy patients performed using the piezoelectric device (50 patients) or the microdrill (50 patients). Main Outcome Measures: Before surgery and at 1 and 12 months afterward, all patients underwent the following: otomicroscopic evaluation of the external and middle ear, pure-tone audiometry, tympanometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, and auditory brainstem response. Results: All patients treated with the piezoelectric device had an air--bone gap reduction, with a closure of the air--bone gap within 10 dB; 44 (88%) patients who underwent traditional surgery had an air--bone gap reduction, with a closure of the air--bone gap within 10 dB. Conclusion: All of our postoperative data confirm the safety of the device on the anatomic structures of the middle and inner ear and demonstrate the efficacy of the piezoelectric device in terms of safety, cutting precision, and protection of anatomic structures and its applicability to stapedotomy. [ABSTRACT FROM AUTHOR]