Congenital stapes suprastructure fixation presenting with fluctuating auditory symptoms:A case report

BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive conductive hearing loss that typically began in the early years of life.CASE SUMMARY Herein,we report a case of a 37-year-old female with an isolated stapedial suprastructure fixation.The patient presented with unusual fluctuating auditory symptoms of tinnitus,ear fullness and mixed hearing loss.Pre-operative temporal bone computed tomography findings and operative findings revealed an isolated stapedial suprastructure fixation with monopod stapes caused by elongated pyramidal eminence.The hearing threshold recovered completely,and fluctuating auditory symptoms disappeared after the surgery.CONCLUSION This is the first report of stapedial suprastructure fixation with fluctuating auditory symptoms.Successful results are expected with surgical treatment.

Nonlinear dynamic response and stability analysis of the stapes reconstruction in human middle ear

Stapes fracture causes hearing loss and instability in the middle ear hearing system(MEHS). The material used in the stapes reconstruction restores stapes, but the effects of the nonlinear material parameters on the stability of the MEHS are still unknown. To address this challenge, the nonlinear dynamic response and stability of the stapes reconstruction are investigated using a multi-degree-of-freedom mechanical model. The material parameters of the implant are tentatively determined by analyzing the natural frequencies of the undamped system. The dynamical properties of the MEHS are characterized under different external excitations. The approximate solution of the MEHS near the resonant frequency is derived through the multiple-time-scale method(MTSM). The results show that the nonlinear stiffness of the material has little influence on the MEHS in the healthy state, but it causes resonant phenomena between the ossicle and the implant in the pathological state.

Hyperacusis and stapes surgery:An observation in fifty patients after stapedotomy

Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patients(35 females,mean age=46.8 years).Intervention:All patients underwent stapedotomy.The validated Portuguese version of the“Hyperacusis Questionnaire”(HQ)was administered before and two weeks and one month after surgery.Results:No hyperacusis was reported by any patient before surgery.At two weeks after surgery,all patients experienced hyperacusis,with a mean HQ at 16.88±6.54(range 4e25).One month after surgery,hyperacusis had already resolved in most patients.Gender,preoperative presentation or surgeon had no influence on HQ scores(p>0.05).Patients with previous contralateral stapedotomy showed lower HQ scores(p=0.001).Audiological parameters improvement measured at one month after surgery(PTA,SRT and contralateral SRT)were associated with HQ higher scores.Conclusion:This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery.The HQ highest scores were registered among patients with the highest audiological gain after surgery.This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.

Preferences in stapes surgery among American otological society otologists

Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

鼓室硬化症

鼓室硬化症是常见的引起传导性听力下降的中耳疾病之一,和慢性中耳感染密切相关,被认为是慢性化脓性中耳炎的后遗症,近年逐步受到关注,但引起鼓室硬化的具体原因、发病机制和预后转归尚不明确。本文主要就鼓室硬化症的临床诊疗现状做一总结。

Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization

Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.

Classification of facial nerve aberration in congenital malformation of middle ear:Implications for surgery of hearing restoration

Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.Methods: A retrospective study involving review of clinical data of 227 patients(256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography(CT) data, surgical records and videos.Results: Aberration involving intratemporal facial nerve was found in 82/256 ears(32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window(50/82 ears, 60.98%), bifurcation(3/82 ears, 3.66%) and transverse over the promontory(3/82 ears, 3.66%), counting for 68.29%(56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears(92.68%) and atresia or stenosis of the oval window in 27/82 ears(32.93%). In 9/82 ears(10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis(TORP) implantation and Vibrant Soundbridge(VSB) implantation.Conclusion: The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.

Malleostapedotomy for otosclerosis,our experience of nitinol piston on twelve patients

Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it remains gold standard for cases of extensive necrosis,incus dislocation,or epitympanic fixation.Modern heat-crimping pistons make surgery easier and safer.This study focuses on our experience with this technique.Methods:Retrospective analysis of patient’s files and pre-and post-operative audiograms,for cases of surgically treated otosclerosis with malleostapedotomy.Results:Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019.Amongst them there were 10 revision surgeries and 2 primary cases.75%had incus long-process necrosis,17%had epitympanic fixation and one had a history of incus transposition.Nine patients(75%)had closure of air-bone gap(ABG)of<10 dB(p<0.001)and 11(92%)had a threshold of 20 dB(p<0.001).Mean pre-operative ABG was 31 dB(15 dBe55 dB),and mean post-operative ABG was 7 dB(0 dBe21 dB;p<0.001).There was no sensorineural hearing loss nor any other post-operative complication.Conclusions:Malleostapedotomy is a safe and reliable technique,allowing an ABG closure comparable to conventional incus to vestibule prosthesis.It remains the preferred technique whenever the incus cannot be used.

Post-Stapedectomy Granuloma: A Rare Case Report

Reparative granuloma in the oval window region is an uncommon complication of stapes surgery, which usually develops within one to eight weeks after operation and causes a sudden hearing loss and disturbance of balance. It may also cause otalgia. Because of its rarity, no single centre would be able to give conclusive evidence regarding this complication. Hence we would like to report our experience and hope to get a better understanding regarding the stapes surgery induced granulation.

Microdrill,Diode Laser,and Manual Microsurgical Stapedoplasty:A Comparative Study

Background: To evaluate hearing outcome, operation time and post-operative hospital stay after primary stapedoplasty with three different techniques: manual microsurgical, microdrill-assisted, and microdrill- and laser-assisted technique. Methods: A retrospective analysis of 150 consecutive cases of primary otosclerosis was operated by one surgeon. The patients were divided into three groups depending on the utilized surgical techniques: a fully manual microsurgical stapedoplasty (n = 56), microdrill-assisted stapedoplasty (n = 32), and microdrill- and laser-assisted stapedoplasty (n = 62). The mean pre- and post-operative air-bone gap was calculated by using pre- and post-operative mean pure tone air- and bone-conduction thresholds at 500, 1000, 2000 and 4000 Hz. Results: There were no statistically significant differences in the hearing outcome between the groups. The closure of air-bone gap and the improvement of the hearing were demonstrated in all study groups. Introduction of diode laser for stapes surgery resulted in significantly reduced operation time (about one-third) and the increase in the completion of surgery from 81.5% to 96.7%. At the same time, the rate of complications stayed low and hospital stay dropped from three days to one day. There were no major post-operative complications in any study groups. Conclusions: Application of diode laser in stapes surgery significantly reduced operation time and increased completion rate of surgery. No statistically significant difference was found between three surgical techniques regarding hearing outcome.