The distance between stapedial footplate and incus in otosclerosis surgery

Background: The measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome.Objective: To determine the piston length in a group of otosclerosis patients who underwent primary stapedotomy.Material and methods: Between Sep 2013 and Sep 2014, 85 patients with diagnosed otosclerosis underwent primary stapedotomy. Teflon prosthesis of 0.6 mm of diameter was used in all patients. The distance between medial surface of the long process of incus and center point of the stapedial footplate measured. The piston length calculated by adding 0.25 mm for the thickness of footplate and 0.50 mm for placement of the prosthesis into the vestibule.Results: The distance between stapedial foot plate and incus ranged from 3.50 to 4.50 mm. The mean distance was 3.95 ± 0.16 mm. In majority of cases(74.1%) piston length was 4.75 mm followed by 4.50 mm in 15.3% and 5.00 mm in 5.9%. Piston length was 4.25 mm in 3.5% and5.25 mm in only 1.2% of patients. There was no significant post-operative complication and air bone gap closure obtained in all patients.Conclusion: The most common distance between foot plate and incus is 4.00 mm. No case needed a piston longer than 5.25 mm or shorter than4.25 mm.

Complete restoration of congenital conductive hearing loss by staged surgery: A case report

BACKGROUND Stapedial tendon ossification is a rare disease,with only a few reports.The stapedial tendon originates from the apex of the pyramidal eminence and is attached to the neck of the stapes.In stapedial tendon ossification,the stapes is fixed,causing conductive hearing loss.In most cases,complete hearing restoration is achieved by dividing the stapedial tendon after exploratory tympanotomy.CASE SUMMARY A 28-year-old woman presented to our hospital with the major complaint of bilateral hearing loss that started during childhood.Exploratory tympanotomy was performed due to suspicion of otosclerosis or middle ear anomalies.We found bilateral conductive hearing loss due to stapedial tendon ossification with a middle ear anomaly during surgery.There have been several reports of complete recovery of hearing after resection of the stapedial tendon.However,in this case,recovery of hearing was insufficient,even with the division of the stapedial tendon.In the second surgery,the stapes anomaly and footplate fixation were confirmed,and hearing was completely recovered after stapedotomy.Therefore,we report this case with a review of the relevant literature.CONCLUSION This is the first case of stapedial tendon ossification and fixation of the footplate surgically diagnosed on both sides.With surgical treatment,successful results are expected.

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.