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Introduction Otosclerosis leads to stapes fixation and consequent conductive hearing loss. Surgery is the mainstay of treatment, and it can be achieved through small fenestra stapedotomy or stapedectomy. Despite the first being favored by most, evidence supporting its superiority over the latter remains inconclusive. Objective To assess the hearing outcomes and complications of stapes surgery performed in a series of patients with otosclerosis and compare the results of stapedotomy with stapedectomy. Methods A retrospective study of 134 ears in 125 otosclerosis patients undergoing primary stapes surgery was conducted. Patients underwent either stapedotomy or stapedectomy, and outcomes were compared using pre- and postoperative audiometric data and complication rates. Results Most cases (81%) underwent stapedotomy. Both techniques resulted in significant improvement in air-bone gap (ABG) and speech recognition threshold (SRT) postoperatively, with no significant difference between them. Complication rates were comparable between techniques, with no statistical difference in postoperative complications. Conclusion Both stapedotomy and stapedectomy offer favorable hearing outcomes with low complication rates in otosclerosis patients. While stapedotomy remains the preferred technique, if the initial plan shifts to a stapedectomy, surgeons should remain composed and confident in a good hearing outcome. [ABSTRACT FROM AUTHOR]

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

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]

Background: Otosclerosis is one of the most frequent causes of conductive hearing loss in adults. Surgical treatment is considered to be the gold standard for this disease. Endoscopic stapedectomy is a new approach for the treatment of otosclerosis that requires a bloodless field. Aim of the Study: To determine whether the routine use of β blockers as a premedication can improve the operative field in endoscopic stapedectomy or not. Patients and Methods: Sixty patients aged from 18 to 50 years, undergoing endoscopic stapedectomy, were included in this prospective, randomized, double blinded, placebo-controlled study. Patients were randomly assigned to receive either metoprolol 100 mg (group 1) or a placebo, vitamin tablet, (group 2) 60 min before surgery. Results: The age, gender, body weight and ASA physical status were comparable between the two groups. The average blood loss in the placebo group was significantly greater than in the metoprolol group, but the time of operation in the metoprolol group was not significantly shorter. The surgical field was assessed using the Fromme-Boezaart scale, and those who received metoprolol had considerably cleaner (p0.001) surgical fields. The mean arterial pressure (MAP) didn't differ statistically significant at basal measurement up to 30 min after anesthesia induction while it was significantly lower in the metoprolol group after 30 min of induction up to end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in patients who received metoprolol from prior to anesthesia induction up to end of surgery. Conclusion: metoprolol significantly improves visual clarity and hemodynamics during endoscopic stapedectomy. [ABSTRACT FROM AUTHOR]

Osteogenesis imperfecta (OI) is a group of rare hereditary collagen disorders. Hearing loss (HL) is a known complication linked to changes in the bones of the middle ear seen in OI. We aimed to determine the prevalence, age at debut, incidence, and risk of HL, surgery on bones of the middle ear, and use of hearing aids. A Danish nationwide, register-based cohort study. Data were extracted from the Danish National Patient register. Anyone with an OI diagnosis between January 1st 1977 and December 31st 2018, matched 1:5 with a reference population (Ref.Pop) on birthyear and sex, were included. 864 persons (487 women) with OI were included in the study and 4276 (2330 women) in the Ref.Pop. The sub-hazard ratio (SHR) for any HL was 4.56 [95% CI 3.64–5.71], with a prevalence of 17.0% and 4.0% in the OI cohort and Ref.Pop. Median age at debut was 42 and 58 years, respectively. The risk of otosclerosis and/or surgery was higher in the OI cohort (SHR 22.51 [95% CI 12.62–40.14]), with a median age at debut of 43 and 32 years in the OI cohort and Ref.Pop, respectively. Hearing aid use was more frequent in the OI cohort (SHR 4.16 [95% CI 3.21–5.40]) than in the Ref.Pop. The median age at debut was 45 and 60 years in the OI cohort and Ref.Pop, respectively. Persons with OI have a higher risk and prevalence of HL, hearing aids, and surgery, debuting younger, and prevalence increases with age. [ABSTRACT FROM AUTHOR]

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

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]

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]

Background: Otosclerosis is one of the leading causes of conductive hearing loss with an intact tympanic membrane in adults. The stapedius tendon is routinely transected during stapes surgery. This study aimed to evaluate the success rates of stapedectomy with preservation of the stapedial muscle tendon compared to stapedectomy without preservation of the stapedial muscle tendon in the operative management of otosclerosis. Methods: This is a retrospective study. It was conducted in the Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, from October 2018 to January 2021. The sample size was 36 cases, arranged into two groups: the first group with preservation, and the second group with a cut of the stapedial tendon. The size of each group is 18 cases. Results: There was no significant difference between both groups in hearing improvement, but there was a significant difference between both groups in post-operative tinnitus improvement and acoustic reflex preservation. Conclusions: Preservation of the stapedial tendon in the surgical treatment of otosclerosis is associated with improvement in functional outcomes as well as providing the patient with a stapedial reflex that has a primary protective effect against strong acoustic stimuli. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: The purpose of this study was to examine the quality of life (QoL) and hearing thresholds of patients who underwent 2 types of stapes surgery. METHODS: A retrospective cohort study was performed comparing stapedotomy with NiTiBOND prostheses (n=20) and stapedectomy with autogenous cortical bone columella (n=20), applying the Glasgow Benefit Inventory (GBI) and the Hearing Handicap Inventory for Adults outcome measures with hearing thresholds. Univariate comparative statistical methods were applied. RESULTS: The stapedotomy cohort had significantly better values of Social Support Score of the GBI as compared to the stapedectomy cohort (P=.016). No statistically significant difference was detected between the groups in the pre- and postoperative audiological results and the further QoL measures. CONCLUSION: Apart from the excellent postoperative audiological results of the different types of stapes surgeries, stapedotomy with NiTiBOND prostheses seems to be superior as regards QoL over stapedectomy applying autogenous cortical bone columella. [ABSTRACT FROM AUTHOR]

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.

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]

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]

The aim of this study is to investigate the intraoperative and postoperative results of endoscopic stapes surgery performed at our institution. A total of 25 patients with 28 ears (14 right, 14 left ears) who underwent endoscopic stapes surgery between 2018 and 2022 were analysed for postoperative hearing outcomes and surgical complications at the 6-month follow-up. The average age of the patients was 43.16 years (range, 24-63 years), and 64.0% of the patients were female. The median preoperative air-bone gap decreased from 30.36 dB hearing level (HL) to 18.95 dB HL after surgery (P < 0.001). The postoperative air-bone gap was 10 dB or lower in 8 ears (28.6%), 11-20 dB in 10 ears (35.7%), and more than 20 dB in 6 ears (21.4%). Worse hearing outcomes were observed in 4 ears (4.14%). Intraoperative complications included only tympanic membrane ruptures in one patient, which resolved during the initial follow-up. Postoperatively, 10.7% of the subjects complained of changes in taste sensation. One patient developed facial paralysis responsive to steroid treatment one week after surgery. Endoscopic surgery is particularly suitable for stapedial disorders. Endoscopic stapes surgery is minimally invasive and suitable for surgical training, as surgical anatomy can be easily understood, and both the surgeon and assistant can observe the procedure from the same monitor. The operation should only be performed by experienced surgeons due to the need for single-handed operation and the lack of stereoscopic vision. [ABSTRACT FROM AUTHOR]

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Introduction Otosclerosis is a common cause of conductive hearing loss in the adult population that is caused by fixation of the stapes footplate. Cochlear otosclerosis may also present with sensorineural or mixed hearing loss. Surgery is the definitive treatment of choice and, during the procedure, sealing of the oval window with autologous tissue graft around the stapes prosthesis has been routinely done to improve hearing outcome and to mitigate postoperative complications. Objective To evaluate the efficacy of two different types of autologous tissue (vein or fat) grafts as oval window sealing materials in stapedotomy in improving short-term hearing outcomes. Methods In our study, 70 patients with otosclerosis who underwent primary stapedotomy were included. They were divided into group 1 (vein graft) and group 2 (fat graft) based on the type of sealing material used. All patients were followed-up at the end of 3 months, undergoing an audiometric examination to assess the hearing outcome. Results A total of 80% (n = 28) of the patients in group1 had an air-bone gap (ABG) closure < 10dB, and, in group 2, 85.7% had an ABG closure < 10 dB; this difference was found to be statistically insignificant. A total of 42.9% (n = 15) of the patients in group 1 and of 31.4% (n = 11) in group 2 had a significant improvement in bone conduction, while 14.3% (n = 5) of the patients in group 1 and 17.1% (n = 6) in group 2 had worsening of average bone conduction postoperatively, which was found to be statistically insignificant. Conclusion Both vein and fat grafts had comparable effects on hearing outcomes when used as sealing materials in stapedotomy. [ABSTRACT FROM AUTHOR]

BACKGROUND. Otosclerosis is a primary disease of the human otic capsule and stapes stage, being a frequent cause of conductive hearing loss in our country. The surgical treatment of choice is stapes surgery and prosthesis placement, performed in a conventional way, with a surgical microscope, for 30 years in our hospital. Recently, the option of performing stapes surgery endoscopically was introduced in our centre. OBJECTIVE. To evaluate the results in stapes surgery for otosclerosis between the conventional microscopic versus endoscopic procedure. MATERIAL AND METHODS. An observational, analytical and retrospective study on patients undergoing stapes surgery with microscopic and endoscopic technique was conducted. Data such as age, sex, state of origin, affected ear, as well as the technique used, duration of surgical intervention, hearing gain and postsurgical complications were taken. Data were taken from the records of patients admitted to the hospital. Descriptive statistics, Mann-Whitney U and Pearson's Ji2, were used, considering a value of p≤ 0.05 as significant. RESULTS. No significant differences were found in surgical time or postoperative hearing between the two surgical techniques. The female sex was the most intervened. There was no significant difference between the post-surgical complications of both groups. CONCLUSION. Both procedures appear to be effective, with similar risks and postoperative results for the surgical treatment of otosclerosis. [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]

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

Far-advanced otosclerosis (FAO) refers to severe otosclerosis with scarce auditory functions. The identification of the best method to correctly listen to sound and speech has a large impact on patients' quality of life. We retrospectively analyzed the auditory function of 15 patients affected by FAO who were treated with stapedectomy plus hearing aids independent of the severity of their auditory deficit before surgery. The combination of surgery and hearing aids allowed excellent recovery of the perception of pure tone sounds and speech. Four patients, because of poor auditory thresholds, needed a cochlear implant after stapedectomy. Despite being based on a small sample of patients, our results suggest that stapedotomy plus hearing aids could improve the auditory capacities of patients with FAO independent of their auditory thresholds at T0. The careful selection of patients is fundamental to obtain the best outcomes. [ABSTRACT FROM AUTHOR]

Stapedotomy or stapedectomy operations are often performed to treat otosclerosis. During the operation, the space created by bone removal is usually filled with a closing material such as fat or fascia. In this study, the effect of the Young's modulus of the closing material on the hearing level was investigated through the 3D finite element model of a human head including auditory periphery. The Young's moduli of the closing material used to implement stapedotomy and stapedectomy conditions in the model were varied from 1 kPa to 24 MPa. The results showed that the hearing level improved when the closing material was more compliant after stapedotomy. Therefore, when the stapedotomy was performed using fat whose Young's modulus is lowest among the potential closing materials, the hearing level recovered the best among all simulated cases. On the other hand, in stapedectomy, the Young's modulus did not have the linear relationship between the hearing level and the compliance of the closing material. Hence, the Young's modulus causing the best hearing rehabilitation in stapedectomy was found not at the end of the investigated range of Young's modulus but somewhere in the middle of the given range. [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]

Stapes surgery is generally performed to treat otosclerosis, and there are numerous surgical techniques and prosthesis materials available. Critical evaluation of postoperative hearing outcomes is crucial for identification and further improvement of treatment options. This study is a non-randomized retrospective analysis of hearing threshold levels before and after stapedectomy or stapedotomy in 365 patients during a twenty-year period. The patients were classified into three groups depending on the prosthesis and surgery type: stapedectomy with Schuknecht prosthesis placement and stapedotomy with either Causse or Richard prosthesis. The postoperative air-bone gap (ABG) was calculated by subtracting the bone conduction pure tone-audiogram (PTA) from the air conduction PTA. Hearing threshold levels were evaluated preoperatively and postoperatively from 250 Hz to 12 kHz. The results showed air-bone gap reduction

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

ObjectiveTo describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis.PatientsA retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded.InterventionsAll patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started.Main outcome measureChanges in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution.ResultsFour women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments.ConclusionsPersistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo.

Objectives: To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect. Methods: Retrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary centre. Main outcome measures: Change in bone conduction after stapedectomy for otosclerosis in: unilateral otosclerosis (U1); bilateral otosclerosis undergoing first side surgery (B1); bilateral otosclerosis undergoing second side surgery (B2). The magnitude of change in bone conduction post-operatively within and between each group. Results: The average difference in pre and post-operative bone conduction was significant within in all groups (T-stat > 2 and P-value

Objective: Limited data are available on the effects of otosclerosis and otosclerosis surgery on the utricle and saccule. This study aimed to determine the effect of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials. Methods: This retrospective study included 16 otosclerosis patients and 18 controls. Thirty-two ears of 16 patients with otosclerosis were divided into 2 groups based on whether the ear had been operated on or not. All patients and subjects underwent 500 Hz air- and bone-conducted ocular and cervical vestibular-evoked myogenic potentials testing. Results: Overall comparison of response rates showed a significant difference among the groups. Further statistical tests showed that this difference arose from differences between both operated and unoperated groups and the control group, for air-conducted cervical and ocular vestibular-evoked myogenic potentials. Conclusion: Otosclerosis and stapedotomy may affect the elicitability of vestibular-evoked myogenic potentials. Otosclerosis is associated with lower response rates for air-conducted ocular and cervical vestibular-evoked myogenic potentials, regardless of whether operated on. Having been operated on does not significantly increase the response rate of air-conducted vestibular-evoked myogenic potentials. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate short and long term results of stapes surgery in patients with osteogenesis imperfecta (OI), Methods: Retrospective case series of 18 primary stapes surgeries performed on 11 hearing-impaired OI patients with evidence of stapes fixation, in a Tertiary referral center. We analysed pre-operative and post-operative hearing results at 1 month and at least 1 year Results: The main operative findings were stapes fixation, thickened footplate and fragile or fractured stapes crura. No revision surgery was necessary. Hearing improvement was achieved in 94% of the cases. We obtained an air–bone gap closure to within 10 dB in 46% of the cases and to within 15 dB in 92% of the cases at 1-year follow-up. The mean hearing gain in air conduction (at 0.5, 1, 2 and 4 kHz) was 18.4 dB at 1 month and 22.4 dB at 1 year. Conclusion: Stapes surgery in OI gives good results with few complications in our series. A hearing gain is often obtained in spite of the sensorineural hearing loss caused by the natural progression of the disease [ABSTRACT FROM AUTHOR]

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

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

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

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

My father was a true blue “promdi” from Angeles City, Pampanga. A son of a humble businessman who grew up with 3 siblings. A happy-go-lucky teenager who sometimes got into trouble with the usual traps of growing up and never really cared about his future. With the carefree attitude growing up, he was given an ultimatum by my grandfather. “Son, if you won’t study and don’t get serious with your life, you will be a bum or a beggar on the street.” Having an epiphany, he started getting inspiration from an uncle who was an EENT doctor -- observing in his clinic during summer and that started the fire that built his career of becoming a doctor. He graduated from the University of Santo Tomas Faculty of Medicine in Manila in 1959 then flew to the United States and had seven years of specialization -- first at the Elmhurst Hospital, New York City where he became Chief Resident in Otolaryngology. Not content with his training in ENT he decided to take a second specialty in Ophthalmology, with a three-year residency in Toronto East General Hospital in Canada. He could have stayed in North America to practice but opted to return to his hometown and serve his fellow Kapampangans, establishing Clinica Henson Eye, Ear, Nose and Throat Center in Angeles City. He always liked to tell stories about his residency training days in the US. They did a lot of stapedectomy cases during those times and after every procedure the surgeon whispered in the ear of the patient and asked, “Who is the president of the United States” and the patient should answer “John F. Kennedy.” A memorable situation was while he was doing a tonsillectomy, the nurse said out loud that JFK had been just been assassinated. The most memorable memento he brought home after his training was a Zeiss operating microscope. His mentors told him he should buy one and bring it home to better diagnose and manage ENT cases especially otologic procedures. They said it was a good investment since his children could also use it in their future practice. I’m happy and proud to say that we still use this microscope in our clinic OPD in Angeles City. His thirst for learning and improving his craft continued as he grew his practice. He did further training in Facial Plastic and Cosmetic Surgery in the 70’s at the University of California at Davies Sacramento USA and Shirakabe Clinic Osaka, Japan with the guidance of his mentor Dr. Jose Mathay. He eventually set up a cosmetic surgery clinic along Roxas Blvd in the 80’s and was one of the founding members of the Philippine Society for Cosmetic Surgery. His core competence was Rhinoplasty using silicone implant during those days. My mom, a fine arts graduate and portrait artist, helped in carving and designing the silicone implants. I must say that they were a perfect combination. Most of his patients were the wives of military officers and personnel from Clark Air Force base during the 70’s and 80’s. He also practiced in St. Luke’s Medical Center, Quezon City. Passion for teaching also led him to be a Professor of Otolaryngology at the University of the East Ramon Magsaysay Memorial Medical Hospital and Angeles University Foundation. I remember one of his students in UERM told me that his lectures also included life lessons, how to enjoy your practice and how to be a well-rounded doctor. He inspired a lot of students and residents who trained under him. Growing up as the child of a doctor, my siblings and I were enthralled by his life as a medical man. He was well-respected in the community not just in medicine but also in government service. His passion to serve brought him into politics and he once served as a provincial Board Member of the province of Pampanga during the Cory Aquino administration. He was also very active in the Rotary Club both locally and internationally. He was a people person and everyone knew him. He had that certain charisma that lights up the room. As a family, we were known to be a tennis team. Everybody played including my mom and my brothers. He also enjoyed playing golf with my mom-- and don’t even ask who was the better player! Family dinner was usually spent in debates about medical and surgical cases with my mother as the referee. He really took care of his patients. He always reminded us to give the best service to our patients because they travelled from faraway places just to see you. He never gave up even on challenging cases. I was always in awe when I saw him do local anesthesia on patients undergoing tonsillectomy and Caldwell Luc procedures after my residency. He always advocated using local anesthesia on almost all his surgical procedures. Seeing patients with him in the clinic has taught me a lot but it was also interesting and challenging because we sometimes debated on treatments in front of a patient. I enjoyed travelling with him during conferences and courses abroad. He liked to update himself by observing in FESS, temporal bone and oculoplasty courses. These were our bonding moments as father and son and also with my brother Raoul who is an ophthalmologist[1]oculoplastic surgeon. One thing I miss most about him is when we used to do surgery together. When my brother and I encounter difficult or challenging cases he was always there to provide advice on how to go about it. I am indeed lucky to have a father with the same passion and vocation. I hope I can continue the legacy with my children. I hope my father remains to be an inspiration to his former students and residents. A true gentleman to his family, profession and the community he served.

The article describes the case of a 50-year-old woman who experienced perilymphatic fistula that manifested as a pseudomeningocele-like presentation following stapedectomy. Otoscopy showed intact tympanic membranes bilaterally with aerated middle ear spaces. The primary pathology which led to the pseudomeningocele-like presentation was a cerebrospinal fluid oozer following the stapedotomy. The management of pseudomeningoceles is discussed.

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]

Background Stapes surgery success depends on several factors, including the length of the prosthesis used. Whether to use a standard-size prosthesis or measure the length of the stapes prosthesis has been debated in the literature. This study aims to assess the surgical outcomes of a stapedotomy using the standard 4.5 mm prosthesis without custom measurements. Methodology This retrospective study involved patients with otosclerosis who underwent primary stapedotomy using a standardized 4.5 mm fixed-length prosthesis between January 2017 and February 2023 at a tertiary care center. Results Out of 111 charts reviewed, 99 ears (56 males and 43 females) were studied. The mean air-bone gap (ABG) significantly improved from 27.9 ± 9.12 dB preoperatively to 3.95 ± 3.54 dB post-operatively (p-value < 0.05). Hearing results showed that out of 99 ears, 96.96% had a postoperative ABG of ≤10 dB and 98.98% ≤20 dB. Only three patients showed postoperative mild transient dizziness that lasted a few days. None of the patients had persistent dizziness for more than one week. One patient developed postoperative reparative granuloma with tinnitus and sensory-neural hearing loss. None had a recurrence of the conductive hearing loss during the study period. Conclusion Our retrospective study on stapes surgery utilizing a standardized 4.5 mm prosthesis without custom measurements showed notable surgical success and safety. Using a standard-size prosthesis shortens the surgical time and eliminates the complexities associated with intraoperative measurements, potentially reducing the risk of complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Hamad Medical Corporation Surgical Section Committee issued approval SR/RE/2022/18. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hammoud et al.)

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]

During stapes surgery, the Teflon wire piston prosthesis is prone to postoperative 'slips' and subsequent necrosis and fracture of the long process of the incus. We invented and used a novel cup-shaped apatite prosthesis to reduce the incidence of necrosis of the long process of the incus and analysed the postoperative results. Thirty-one ears in 25 patients with otosclerosis who underwent stapes surgery with our apatite prosthesis were evaluated. The air conduction improved by 24.0 dB (the average) from pre- to post-operation. Additionally, 84.8% of patients achieved an air–bone gap of ≤10 dB for the 4-frequency measurements (p <.01). Our findings indicate that our new prosthesis was associated with a good postoperative prognosis in patients with otosclerosis. Our unique prosthesis yielded good outcomes for the treatment of otosclerosis even in the short term. [ABSTRACT FROM AUTHOR]

Introduction: For many years, surgical treatment of otosclerosis has been a widely accepted approach. Hearing improvement following stapes surgery is sometimes spectacular, and good treatment results are obtained in many centers in over 90% of patients. However, in the subsequent years after the treatment, some patients develop permanent or progressive conductive hearing loss. Aim: The aim of the study is to present a group of patients with conductive hearing loss after the first otosclerosis surgery and to analyze the causes of its occurrence. Materials and Methods: The retrospective review covered patients who underwent the initial surgery in the years 2000-2009. We analyzed the patients' medical records from before the end of 2019, which provided results of at least 10 years of postoperative follow-up. The group consisted of 1118 patients aged 14-82, including 802 women and 316 men. Results: Reoperations due to conductive hearing loss were performed on 93 patients, who accounted for 8.3% of the originally operated patients. They were much more common in patients after stapedectomies (19.7%) than in patients after stapedotomy (5.5%). Prosthesis dislocation was found to be the most frequent intraoperative observation (44.1%) and was often associated with erosion or necrosis of the long process of incus (28%). Less frequent reasons for hearing loss were: adhesions around the prosthesis (10.8%), too small hole in the stapes footplate (8.6%), too short prosthesis (8.6%), progression of otosclerosis (7.5%), too long prosthesis (6.4%), presence of a granuloma around the prosthesis (5.4 %), and displacement of incus (4.3%). Conclusions: Surgical treatment of otosclerosis is a widely accepted and good method. It allows to achieve an improvement in hearing in the vast majority of patients treated in this way. Unfortunately, over the years some patients develop recurrent conductive hearing loss. Reoperation creates an opportunity for finding the cause and improving hearing in the majority of cases. [ABSTRACT FROM AUTHOR]