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.

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.

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.