Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situatio...Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situations.Methods:This is a retrospective analysis of cases where a total of 46 patients(22 in conventional stapedotomy and 24 in CO_(2) laser‐assisted stapedotomy)were included in the study.The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.Results:A total of 90.90%(20/22)of the patients in the conventional stapedotomy and 95.83%(23/24)of patients in laser‐assisted stapedotomy had<20 dB of AB gap in the postoperative period(P=0.71).Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same(P=0.01).Chorda tympani nerve was manipulated in 59.09%(13/22)and 25.00%(6/24)of cases in the conventional group and in the CO_(2) laser group,respectively(P=0.01).Conclusion:Although the audiological outcomes with fiber‐enabled CO_(2) laser in endoscopic stapedotomy are comparable to conventional surgery,it is a better tool in a narrow auditory canal,requiring minimal manipulation of the chorda tympani nerve.展开更多
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 ...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.展开更多
Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or grad...Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or gradual hearing loss after a successful air-bone gap closure in the follow-up period. The issue of re-exploring the middle ear is challenging. A general review of this subject from several points of view remains lacking. In this study, articles related with the revision surgery for otosclerosis have been reviewed after a Pub Med research and common and/or contradictory points were documented. The aim of this study is to give an insight to diagnostic and therapeutic approaches forthe clinicians in patients who need a revision surgery. In conclusion, prosthesis problems, loose prosthesis in stapedotomy and migrated prosthesis in stapedectomy are the most common causes for revision surgery. Most important indicators which effect better hearing outcome following revision surgery are those ears with the presence of incus, with no obliteration of oval window, with small fenestra stapedotomy and the experience of surgeon. The risk of neurosensorial hearing loss in revision cases is not high but the hearing gain is limited as compared to primary cases. The rate of 10 d B air-bone gap closure is around 60%-70% at most and even less promising results have been reported. Patient's demands and expectations have to be clarified in a realistic way.展开更多
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 commo...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.展开更多
文摘Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situations.Methods:This is a retrospective analysis of cases where a total of 46 patients(22 in conventional stapedotomy and 24 in CO_(2) laser‐assisted stapedotomy)were included in the study.The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.Results:A total of 90.90%(20/22)of the patients in the conventional stapedotomy and 95.83%(23/24)of patients in laser‐assisted stapedotomy had<20 dB of AB gap in the postoperative period(P=0.71).Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same(P=0.01).Chorda tympani nerve was manipulated in 59.09%(13/22)and 25.00%(6/24)of cases in the conventional group and in the CO_(2) laser group,respectively(P=0.01).Conclusion:Although the audiological outcomes with fiber‐enabled CO_(2) laser in endoscopic stapedotomy are comparable to conventional surgery,it is a better tool in a narrow auditory canal,requiring minimal manipulation of the chorda tympani nerve.
文摘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.
文摘Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or gradual hearing loss after a successful air-bone gap closure in the follow-up period. The issue of re-exploring the middle ear is challenging. A general review of this subject from several points of view remains lacking. In this study, articles related with the revision surgery for otosclerosis have been reviewed after a Pub Med research and common and/or contradictory points were documented. The aim of this study is to give an insight to diagnostic and therapeutic approaches forthe clinicians in patients who need a revision surgery. In conclusion, prosthesis problems, loose prosthesis in stapedotomy and migrated prosthesis in stapedectomy are the most common causes for revision surgery. Most important indicators which effect better hearing outcome following revision surgery are those ears with the presence of incus, with no obliteration of oval window, with small fenestra stapedotomy and the experience of surgeon. The risk of neurosensorial hearing loss in revision cases is not high but the hearing gain is limited as compared to primary cases. The rate of 10 d B air-bone gap closure is around 60%-70% at most and even less promising results have been reported. Patient's demands and expectations have to be clarified in a realistic way.
文摘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.
