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Objective: To evaluate the effect of pregnancy on the hearing of women with otosclerosis. Study Design: A retrospective study of women who had undergone stapedectomy. The women were equally divided into two groups: one group with children and a control group without children. Air and bone conduction, as well as discrimination, were measured before and after stapedectomy in both groups. Patients: Ninety-four women (47 with children and 47 without) were evaluated. Because many of the women had bilateral otosclerosis, the total number of ears studied was 128. Results: Mean pure tone air and bone conduction thresholds were not worse in women with children versus those women without children. In fact, mean pre- and postoperative pure tone air and bone conduction thresholds from 500 Hz through 4,000 Hz in women with children were slightly but significantly better than women without children. There was no difference in discrimination scores between groups. Within the group with children, no significant correlation was found between number of children and hearing loss. Also, no correlation was found between breastfeeding and the amount of hearing loss. Conclusion: We found no adverse effect on hearing in otosclerotic women who had children compared with women without children. Even with increasing numbers of pregnancies, no deleterious impact was noted. Air conduction, bone conduction, and discrimination were not worse in women with children versus childless women. No significant correlation was found between the number of children and hearing loss, and neither did breastfeeding affect the amount of hearing loss.

Objective: Although stainless steel stapes prostheses have generally been considered magnetic resonance imaging safe, there is concern that this may change with the development of more powerful imaging systems. The objective of the study was to determine whether a titanium piston stapes prosthesis would be audiometrically and surgically equivalent to a Robinson stainless steel piston for stapedectomy. Study Design: Retrospective chart review. Setting: Private otology practice. Patients: In all, 50 patients underwent stapedectomy with a Gyrus titanium piston prosthesis. These patients were matched on the basis of age and preoperative bone-conduction scores with patients who underwent stapedectomy with a Robinson stainless steel piston prosthesis. Main Outcome Measures: Audiometric results are analyzed, and surgical complications noted. Results: There was no significant difference between groups in hearing improvement or postoperative air-bone gap. The mean four-frequency hearing improvement was 27.7 dB for the stainless steel group and 27.8 dB for the titanium group. The mean postoperative air-bone gap was 2.65 dB for the stainless steel group and 2.60 for the titanium group. Neither group had a surgical complication. Conclusion: The titanium stapes prosthesis is a good alternative to a stainless steel prosthesis.

To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies.Retrospective chart review.Tertiary otologic referral center.A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz.Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB.More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.

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

The removal of the portion of the stapes footplate that comes easily is the most consistent and reliable technique for treatment of the stapes footplate in stapedectomy. The correct portion of the footplate can be removed without the use of expensive equipment or unusual maneuvers. This technique uses instruments and techniques that are commonly employed by otologists during routine ear surgery. A randomized comparison of stapedectomy technique in 225 patients found that there was successful closure of the air bone gap (to within 10 dB) whether a small fenestra, a third of the footplate, or all of the footplate was removed. The evolution of this technique over 35 years has led to a technique that is stable, reliable, and reproducible over time. Consistent closure of the air bone gap to within 10 dB is found in 96% of patients. Follow-up has demonstrated that this air bone gap closure is stable over at least 30 years. These results have led us to continue to remove the portion of the stapes footplate that comes easily, usually the posterior one-third, with excellent results in our series of 14,352 stapedectomies.

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

Controversy exists concerning stapedectomy for patients with small air-bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air-bone gap. One hundred fifty-four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure-tone average (PTA) improved 16.7 dB and overclosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overclosing even small air-bone gaps due to otosclerosis.

Objective: Evaluate in stapedectomy the clinical outcome and audiometric results (particularly bone conduction) of drilling the promontory because of a narrow oval window niche. Study Design: Retrospective. Setting: Tertiary referral center, private otology practice. Patients: Twenty-five stapedectomy patients requiring promontory drilling who had surgery between 1995 and 2000. Method: A total of 25 patients were evaluated with a minimum 6-month follow-up. Only patients who required promontory drilling and who had complete preoperative and postoperative audiometric testing including bone conduction were included. Promontory drilling was performed with a skeeter drill to thin the promontory. Twenty-five stapedectomy patients who did not undergo promontory drilling were randomly selected from this same period as a comparison group. Results: In addition to the narrow oval window niche, associated anatomical findings were facial nerve overhang in five patients and an obliterated footplate in three patients. Ninety-six percent of cases were successful (

Objective We evaluated the method of stapedectomy and hearing results in patients who have 50% or more of the footplate covered by a prolapsed facial nerve. Study design We conducted a retrospective review of 1497 primary stapedectomies performed between 1986 and 1995. Methods Twenty-eight patients had 50% or more of the oval window covered by a prolapsed facial nerve. Twenty-three patients in this group had adequate follow-up and their hearing results were compared with a matched control group of 50 patients with normal facial nerve anatomy. Also, facial nerve outcomes and any other complications are reported. Results In the patient group with facial nerve prolapse, closure of the postoperative air-bone gap to 10 dB or less was achieved in 19 of 23 (83%) ears and 16 of 20 (80%) ears at 6 months and 1 year, respectively. At 6 months and 1 year, the postoperative air-bone gap in 47 of 50 (94%) ears and 40 of 43 (93%) ears in the control group had closed to 10 dB or less. The average postoperative air-bone gap was 5.1 dB at 6 months and 6.8 dB at 1 year for the group with facial nerve prolapse. In comparison, the average postoperative air-bone gap in the control group was 3.5 dB and 3.9 dB, respectively. The difference in the hearing results for the 2 groups was not statistically significant. Conclusion When the facial nerve covered at least 50% of the oval window, the poststapedectomy hearing results at 6 months and 1 year were similar to those of a matched control group of stapedectomy patients with a normal facial nerve course. There were no short- or long-term facial nerve complications in either group. In light of these results, we conclude that stapedectomy in patients with significant facial nerve prolapse can be performed safely with good hearing results.

The aim of this study was to evaluate the success of stapedectomy in patients who have previously had a tympanoplasty because of chronic otitis media (COM). Fourteen patients from a private otology practice had undergone tympanoplasty for COM and subsequently underwent stapedectomy. Measurements were taken of the air-bone gap (ABG) closure and pure tone average (PTA) which showed hearing improvement. Patients had a mean 36.9 dB PTA hearing gain with 79 per cent closing the ABG to within 20 dB. The need for stapedectomy alone is a rare occurrence for patients with a history of COM requiring a tympanoplasty. Hearing improvement following stapedectomy in these cases was significant, although somewhat less than following traditional stapedectomy in otosclerosis alone.

One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported as successful in 70% to 80% of cases at 1 year. Little is written about long-term results or the association of erosion with various prostheses. We evaluated 83 cases from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was performed with the patient under local anesthesia, with the use of the Lippy modified prosthesis. Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none worse. At 10 years, success had declined to 50% (7 of 14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21 of 23), dropping to 86% at 10 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24 of 70), a plastic strut in 23%, and a Robinsion prosthesis in 17%. We conclude that the risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis yields good long-term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.

Studies have indicated that stapedectomy can be an effective procedure in children for correcting conductive hearing losses due to juvenile otosclerosis. However, because childhood otosclerosis is rare and children commonly choose to use hearing aids in lieu of undergoing surgery, little outcome data are available. The purpose of this retrospective study was to provide additional outcome data in both the short and the long term. Stapedectomies were performed on 47 children. Preoperative hearing results were compared with 6-month postoperative hearing results. Hearing results for the children who had long-term follow-up (5 years or more) were compared with the 6-month postoperative results. Stapedectomy was successful (postoperative air conduction pure-tone average [PTA] within 10 dB of the preoperative bone conduction PTA) in 91.7% of the cases. The mean over-closure of the preoperative bone conduction PTA by the postoperative air conduction PTA was 0.2 dB. The mean PTA hearing improvement was 32.8 dB. Results from the 21 children (28 ears) who had long-term follow-up indicated an average 0.7 dB/year PTA worsening from the 6-month postoperative PTA. Results from this study provide additional evidence that stapedectomy can be an effective procedure for correcting conductive hearing losses due to juvenile otosclerosis.

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

A stainless steel modified Robinson prosthesis was used when an incus with a missing lenticular process or an eroded long process was encountered during stapes surgery. Of 32 cases, the air-bone gap was closed to within 10 dB of the preoperative bone level in 29.

• Malleus fixation, in addition to stapes fixation, presents a perplexing surgical problem. Should the incus replacement prosthesis procedure be performed or only a stapedectomy? The hearing results of a stapedectomy alone in 45 cases with both stapes and malleus fixation are 70% within 10 dB and 84% within 20 dB of the preoperative bone conduction hearing level. ( Arch Otolaryngol 104:388-389, 1978)

Three unusual ossicular problems encountered in stapedectomy are: floating stapes footplate, partial absence of the incus long process, and otosclerosis combined with a fixed malleus. The surgical techniques advocated in solving these problems are: placing a Robinson prosthesis on the floating footplate, utilizing the Lippy modification of the Robinson prosthesis for the problem incus, and performing only a stapedectomy for malleus fixation and otosclerosis. The hearing results in 242 cases were quite satisfactory and no patient had a further sensorineural loss.