Stapedectomy in the Pediatric Patient

The purpose of this study was to evaluate and compare the results of stapedectomy in pediatric patients with otosclerosis and tympanosclerosis. A retrospective review of 14 patients (15 ears) who underwent stapedectomy from 1993 to 1995 was conducted. In 5 ears stapedectomy for tympanosclerosis was performed; 9 patients had otosclerosis and 1 had Treacher Collins syndrome. Patients were evaluated for preoperative and postoperative air-bone gaps, preoperative and postoperative speech reception thresholds, postoperative air conduction hearing improvement, and preoperative and postoperative speech discrimination. Children with otosclerosis who underwent stapedectomies had an average postoperative airbone gap of 16 dB with an average air conduction hearing improvement of 17.6 dB. Children with tympanosclerosis who underwent stapedectomies had an average air-bone gap of 14 dB with an average air conduction hearing improvement of 28 dB. Stapedectomy is a safe and effective treatment for otosclerosis and tympanosclerosis in pediatric patients.     

Stapedectomy in the treatment of otosclerosis in children

In the years 1994-2000 in the Laryngology Department Silesian Medical Academy in Zabrze 167 stapedectomy were performed in 143 patients with otosclerosis. In this group of patients 11 stapedectomies in 8 children aged from 9 to 17 years were performed. 5.6% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedectomies in children. The postoperative evaluations were performed in the period from 6 months to 6 years after the surgical treatment. In the estimation of the hearing state we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedectomy was successful (postoperative air bone gap within 10 dB of the preoperative bone conduction) in 63.6% of the patients. In 3 cases the air bone gap was lower than 20 dB (27.3%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 5.75 dB level. The results were comparable with the other authors. Stapedectomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.     

晚期耳硬化症CO2激光辅助镫骨开窗术疗效的初步观察

目的　探讨CO2激光辅助镫骨开窗人工镫骨植入术治疗晚期耳硬化症的效果。方法　2010年1月~2014年1月间15例（16耳）临床确诊为晚期耳硬化症的患者在我科接受了CO2激光辅助镫骨开窗人工镫骨植入术,术前言语频率平均气导听阈70.21 dB HL,平均骨导听阈38.49 dB HL,平均气骨导差（air conduction-bone conduction gap,ABG）31.72 dB HL,所有病例术后随访超过半年。结果　术后半年言语频率平均气导听阈 43.7 dB HL,平均骨导听阈28.95 dB HL,平均气骨导差14.75 dB HL,ABG≤20 dB者9耳,占比56.3%,ABG闭合≤10 dB者6耳,占比37.5%。无一例术后出现顽固性眩晕、感音神经性聋及面瘫等严重并发症。结论  CO2激光辅助技术降低了镫骨开窗手术严重并发症的几率,多数患者术后听力明显提高,是一种安全、实用、相对经济的选择。     

Endogenous steroids and otosclerosis

The level of serum hydrocortisone dehydroepiandrosteron-sulphate and testosterone was measured in 11 men and 11 women suffering from otosclerosis, whose surgically removed stapes were histologically proven to be otosclerotic. In one third of the cases, the serum levels of steroid hormones were abnormal. Men had lower levels of dehydroepiandrosteron-sulphate, i.e. adrenocortical hypofunction, while women had higher levels of testosterone. Significant correlation was not shown with duration of symptoms, age, speech discrimination, pure tone audiogram, air-bone gap and/or any connection between otosclerosis and adrenocortical hypofunction. In patients with normal hormone serum levels the mean values of bone conduction did not exceed 15 dB on the speech frequencies, whereas in patients with otosclerosis, and altered levels of steroid hormone the threshold values on pure tone audiometry showed a hearing loss of 25 dB.     

Audiometric analyses confirm a cochlear component, disproportional to age, in stapedial otosclerosis.

OBJECTIVE: To report the preoperative audiometric profile of surgically confirmed otosclerosis. STUDY DESIGN: Retrospective, multicenter study. SETTING: Four tertiary referral centers. PATIENTS: One thousand sixty-four surgically confirmed patients with otosclerosis. INTERVENTIONS: Therapeutic ear surgery for hearing improvement. MAIN OUTCOME MEASURES: Preoperative audiometric air conduction (AC) and bone conduction (BC) hearing thresholds were obtained retrospectively for 1064 patients with otosclerosis. A cross-sectional multiple linear regression analysis was performed on audiometric data of affected ears. Influences of age and sex were analyzed and age-related typical audiograms were created. Bone conduction thresholds were corrected for Carhart effect and presbyacusis; in addition, we tested to see if separate cochlear otosclerosis component existed. Corrected thresholds were than analyzed separately for progression of cochlear otosclerosis. RESULTS: The study population consisted of 35% men and 65% women (mean age, 44 yr). The mean pure-tone average at 0.5, 1, and 2 kHz was 57 dB hearing level. Multiple linear regression analysis showed significant progression for all measured AC and BC thresholds. The average annual threshold deterioration for AC was 0.45 dB/yr and the annual threshold deterioration for BC was 0.37 dB/yr. The average annual gap expansion was 0.08 dB/year. The corrected BC thresholds for Carhart effect and presbyacusis remained significantly different from zero, but only showed progression at 2 kHz. CONCLUSION: The preoperative audiological profile of otosclerosis is described. There is a significant sensorineural component in patients with otosclerosis planned for stapedotomy, which is worse than age-related hearing loss by itself. Deterioration rates of AC and BC thresholds have been reported, which can be helpful in clinical practice and might also guide the characterization of allegedly different phenotypes for familial and sporadic otosclerosis.     

The evaluation of results of the surgical treatment in patients with otosclerosis

The authors presents hearing results in 216 patients with otosclerosis surgical treated. Averaged cochlear reserve in relation to the bone conduction determined before operation was used in this study. The follow-up was 2 months-10 years. Good results was proved in more than 93%, no change in 5% and deterioration in less than 2%. The cochlear reserve up to 10 dB obtained in 59% of all patients. The cases when no changes (and deterioration) after surgical treatment correlated to large anomaly evolution in the structure of the hole drum and extensive focus with otosclerosis.     

The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease

To determine new guidelines for stapedectomy in patients with both Meniere's disease and otosclerosis, we studied the position of the saccular membrane and Reissner's membrane in relation to the stapes footplate in eight temporal bones from patients with Meniere's disease. We also reviewed charts of four patients with both otosclerosis and Meniere's disease who had stapedectomy. Histologic and clinical findings were compared with preoperative bone conduction levels at 500 Hz and at high frequencies. We found that the saccular and Reissner's membranes did not contact the stapes footplate ain bones of patients with preoperative bone conduction levels of 35 dB or better at 500 Hz and no high-frequency loss. We also found that stapedectomy was successful in patients with the same criteria. We therefore conclude that stapedectomy does not increase the risk of sensorineural hearing loss for patients with otosclerosis and Meniere's disease who have bone conduction levels of 35 dB o better at 500 Hz and no high-tone loss, but it is contraindicated for patients with 45 dB at 500 Hz or worse and with high-tone loss.     

Stapedectomy in Patients With Small Air-Bone Gaps

Controversy exists concerning stapedectomy for patients with small air-bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air-bone gap. One hundred fifty-four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure-tone average (PTA) improved 16.7 dB and overclosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overclosing even small air-bone gaps due to otosclerosis.     

智能CO2激光在耳硬化症手术中的应用

目的：探讨应用智能CO2激光辅助 Fisch 人工镫骨术治疗耳硬化症的疗效。方法回顾性分析28例接受智能CO2激光辅助Fisch人工镫骨手术治疗的耳硬化症患者的临床资料,术中均使用智能CO2激光切断镫骨肌腱、后足弓,并行镫骨足板开窗;所有患者术前及术后6个月行纯音听阈测试,记录0．5、1、2、4 kHz 频率气、骨导阈值。结果所有患者术后均未发生永久性眩晕和感音性聋;所有患者手术前后骨导阈值无明显变化,差异无统计学意义（P＞0．05）;术前及术后6个月言语频率气骨导差中位数分别为30．38（23．13,39．38）及9．75（8．25,10）dB,两者差异有统计学意义（P＜0．05）。结论智能CO2激光切断镫骨肌腱、后足弓,行镫骨足板开窗安全便捷,适合在耳硬化症人工镫骨手术中使用。     

Short- and Long-term Results of Stapedectomy In Children

Studies have indicated that stapedectomy can be an effective procedure in children for correcting conductive hearing losses due to juvenile otosclerosis. However, because childhood otosclerosis is rare and children commonly choose to use hearing aids in lieu of undergoing surgery, little outcome data are available. The purpose of this retrospective study was to provide additional outcome data in both the short and the long term. Stapedectomies were performed on 47 children. Preoperative hearing results were compared with 6-month postoperative hearing results. Hearing results for the children who had long-term follow-up (5 years or more) were compared with the 6-month postoperative results. Stapedectomy was successful (postoperative air conduction pure-tone average [PTA] within 10 dB of the preoperative bone conduction PTA) in 91.7% of the cases. The mean over-closure of the preoperative bone conduction PTA by the postoperative air conduction PTA was 0.2 dB. The mean PTA hearing improvement was 32.8 dB. Results from the 21 children (28 ears) who had long-term follow-up indicated an average 0.7 dB/year PTA worsening from the 6-month postoperative PTA. Results from this study provide additional evidence that stapedectomy can be an effective procedure for correcting conductive hearing losses due to juvenile otosclerosis.     

Effect of cochlear reserve on postoperative outcome in otosclerosis

Patients with elevated bone conduction (BC) thresholds are not considered a good candidate for otosclerosis surgery. Sometimes, it might be difficult to decide to operate these patients considering relatively poor cochlear function. However, viewpoints may vary among otologists. This study was undertaken to compare hearing outcome following otosclerosis surgery in patients who had bone conduction (BC) thresholds ≥ 30 dB, and to investigate whether BC thresholds >30 dB has a negative impact on hearing outcome. Medical records of 111 patients who had undergone otosclerosis surgery were reviewed. Of 111 patients, 83 had undergone stapedotomy, and 28 stapedectomy. The patients were grouped based on preoperative four-tone BC threshold. Eighty-seven patients had average BC threshold ≤ 30 dB, and were assigned to good-cochlear reserve group. The remaining 24 patients had average BC > 30 dB, and constituted poor-cochlear reserve group. Pre- and postoperative air conduction (AC) and BC thresholds, air-bone (AB) gap, vocal audiometry results and amount of deterioration in BC were determined. Mean postoperative AB gap was almost the same in both groups (14 and 15 dB) (P > 0.05). Percentage of AB gap = 10 dB favored good-cochlear reserve group (41 vs 29%)(P > 0.05). Analysis of mean hearing gain was slightly in favor of good-cochlear reserve group (19 vs 15 dB) (P > 0.05). Better BC thresholds were obtained postoperatively in good-cochlear reserve group (P < 0.001). Deterioration > 10 dB in BC was observed in 5.7 and 12.5% of the patients with good- and poor-cochlear reserve, respectively (P > 0.05). Based on the results of this small sample-size study, even though BC threshold of 30 dB was not considered a negative factor for hearing gain, otosclerosis surgery might have detrimental effects on postoperative BC thresholds in patients who had BC thresholds >30 dB.     

Stapedectomy for far-advanced otosclerosis.

OBJECTIVE: This study aimed to describe far-advanced otosclerosis and to present the authors' results with stapedectomy in 78 ears with far-advanced otosclerosis. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an Otology/Neurotology tertiary referral center. PATIENTS: Stapedectomy was performed on 78 ears of 60 patients with far-advanced otosclerosis, and the results followed from 1 to 21 years with a mean of 5 years. INTERVENTION: Stapedectomy was performed on all ears with far-advanced otosclerosis. MAIN OUTCOME MEASURE: Hearing for air conduction (AC) and bone conduction (BC), speech discrimination, and impedance were tested on all patients before and after operation. The Rinne test was performed on all ears with a 256-cycle magnesium tuning fork. The pure-tone average for AC and BC was computed for 500, 1,000, and 2,000 Hz. Hearing improvement was defined as air-bone gap closure to 10 dB or less and/or AC improvement of 20 dB or more, with no decline in speech discrimination score of more than 10%. RESULTS: Hearing improvement was achieved in 52 (66.7%) of 78 ears of all operations. In group 1, AC was greater than 90 dB, BC was greater than 60 dB, and hearing improved in 26 (81.2%) of 32 ears of operations. In group 2, AC was greater than 90 dB and no measurable BC and hearing improved in 11 (68.8%) of 16 ears of operations. In group 3, there was no measurable AC and BC greater than 60 dB and hearing improved in two (50%) of four ears of operations. In group 4, there was no measurable AC and BC and hearing improved in 11 (42.3%) of 26 ears of operations. Nonmeasurable BC became measurable in 42.9% of ears, nonmeasurable AC became measurable in 73.3% of ears, and all of these became aidable after operation. CONCLUSIONS: A negative Rinne test result with a 256-Hz magnesium tuning fork proved to be the best test to separate far-advanced otosclerosis from sensorineural hearing loss of other causes. Stapedectomy is of benefit in most ears with profound hearing loss of far-advanced otosclerosis, especially in those ears with some measurable hearing by AC.     

First experience with a new stapes clip piston in stapedotomy.

OBJECTIVE: Hearing results after 23 implantations of a newly designed titanium-clip stapes piston prosthesis (the àWengen Clip Piston prosthesis) in patients with otosclerosis were evaluated. This new type of stapes piston was designed to avoid the crimping onto the incus in stapedotomy. This one clip fits all designs and enables solid fixation by clicking the prosthesis onto the long process of the incus without crimping. STUDY DESIGN: A retrospective pilot study was carried out by microcomputer of the preoperative and postoperative audiological results of patients in whom the titanium-clip stapes piston prosthesis was implanted. SETTING: Ear, nose and throat department of Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. PATIENTS: 23 Patients underwent a stapedotomy for hearing improvement suffering from otosclerosis. implantations of a newly designed titanium-clip stapes piston prosthesis (the àWengen Clip Piston prosthesis) in patients with otosclerosis were evaluated. INTERVENTION(S): The stapedotomy was performed with the àWengen Clip Piston prosthesis. MAIN OUTCOME MEASURE(S): Pre and postoperative audiograms were used to evaluate the hearing gain improvement with the new stapes piston. Especially we looked at the airbone gap closure and the sensorineural hearing after the surgical procedure and compared these with the ones before surgery. RESULTS: The hearing results showed a closure of the pure-tone average air-bone gap to within 10 dB in 56.6% of cases (10 of 23 implantations) and to within 20 dB in 100% (23 of 23 implantations). A residual air-bone gap of greater than 20 dB was seen in the present pilot study. Postoperative overclosure of bone-conduction thresholds was discovered only for the frequency of 2 kHz. Sensorineural hearing loss greater than 10% did not occur, and there was no decline in the speech discrimination. CONCLUSIONS: The use of a newly designed titanium-clip stapes piston prosthesis with a diameter of 0.4 mm gives good results in cases of stapedotomy for otosclerosis. The titanium-clip design is a new development in the evolution of stapes piston prostheses. Surgical introduction, placement, and fixation are not always easy, depending on the anatomy of the middle ear and the thickness of the fixation area on the long process of the incus.     

Diode laser in otosclerosis surgery: first clinical results.

OBJECTIVE: To evaluate the functional results of otosclerosis surgery using diode laser. STUDY DESIGN: Retrospective cohort analysis. PATIENTS: One hundred seven patients operated on for otosclerosis with a diode laser (119 ears, all primary cases) and 141 patients operated on with a conventional technique (141 ears, all primary cases). Revision cases using the diode laser were also described. METHODS: Preoperative tomographic computed scan findings and intraoperative observations were collected. Pure-tone and vocal audiometry was performed preoperatively and postoperatively (at 3 mo and 1 yr). RESULTS: In the laser group, the air-bone gap was 29 +/- 0.8 dB (n= 112) preoperatively and 9 +/- 0.6 dB (n = 58) at 1 year. Air conduction was improved by 22 +/- 1.7 dB at 1 year (n = 58). In the conventional group, the air-bone gap was 32 +/- 0.9 dB (n=127) preoperatively and 10 +/- 0.6 dB (n = 127) at 1 year. Air conduction was improved by 25 +/- 1.1 dB (n = 127) at 1 year. No difference of hearing gain was observed between the 2 groups at 1 year. A decreased rate of footplate fracture was observed with the diode laser (3.6%) compared with the conventional technique (21.3%). CONCLUSION: Diode laser is a reliable and safe device for otosclerosis surgery. The functional results were similar to those reported in other series.     

Different approach for surgery of stapes: Comparison microscopic and endoscopic approach

ObjectiveThis study aimed to discuss the different surgical approach, functional hearing results, which are applied to patients operated with a diagnosis of otosclerosis in our clinic.MethodsThis study includes 92 ears of 84 patients who were operated with the diagnosis of otosclerosis. Air bone gap was calculated before and after the operation in all patients. In addition, endoscopic and microscopic methods can be compared and statistically tested whether there is a difference in air bone gap averages and surgical success. Of the 92 ears operated, 56 were right (61%) and 36 were left (39%). Otosclerosis was detected bilaterally in 61 patients (73%) and unilaterally (27%) in 23 patients. The duration of follow-up ranges from 6 month to ten years, on average 28 months.ResultsIn the microscopic operation group, the air pathway measurement was mean 55.58 dB preoperatively and mean 38.42 dB postoperatively, with a mean decrease of 17.16 dB determined. The decrease between the preoperative and postoperative air pathway values was determined to be statistically significant (t:7.20, p < 0.001). In the microscopic operation group, the air-bone gap value was mean 30.50 dB preoperatively and fell by 15.90 dB to 14.60 dB postoperatively. In the endoscopic group, the air-bone gap value was mean 32.32 dB preoperatively and fell by 13.51 dB to 18.81 dB postoperatively.ConclusionsStapes surgery is a successful method with high success rate and low complication rates in the treatment of otosclerosis. The success rate of endoscopic and microscopic stapes surgery is similar. However, endoscopic stapes surgery is specific and difficult otological surgery that must be performed by surgeons specialised on this subject.     

Surgery for otosclerosis in children

Although otosclerosis in childhood is not common in the United States, we have done 62 stapes procedures in 43 patients who were under age 20 at the time of their initial surgery. There were 16 males and 27 females who developed a conductive hearing loss due to otosclerosis between age 6 and 17. The most common age at onset was 12 and 13 years, perhaps suggesting a relationship to puberty. Of these children and teenagers, 42% had severe oval window otosclerosis. Teflon wire prostheses were used in 33% of the operations and wire loop prostheses in most of the remainder; 27% had preoperative bone conduction of 25 dB or worse, indicating the presence of cochlear otosclerosis. The results of stapedectomy were good and approximately equal to that of adult patients.     

SISI test and adaptation. II. Subjects with conductive hearing defects.

The effect of adaptation of the ear on the SISI test was studied at 500 Hz and 2000 Hz in 43 patients with chronic otitis and in 20 patients with otosclerosis. The mean adaptation was slightly over 10 dB, except in the otosclerosis group at 2000 Hz, for which the value was nearly 20 dB after continuous stimulation at 20 dB SL for 3 min. The mean SISI values ranged from 15% to 31% in the preadaptation tests and from 9% to 31% in the postadaptation tests. The scatter of the pre-and postadaptation SISI scores was wide, making statistical treatment of the results difficult. In the total material 22% of the values at 2000 Hz were positive according to Jerger's classification, and 32% were questionable. Adaptation slightly reduced the proportion of positive values, but there were changes towards both higher and lower levels in the cases of chronic otitis, while all the otosclerosis changes were diminutions.     

Sodium fluoride: effectiveness of treatment for cochlear otosclerosis

We examined the effectiveness of sodium fluoride in treatment of cochlear otospongiosis in ninety-four patients with cochlear otosclerosis and ninety-eight patients with stapedial otosclerosis and sensorineural hearing loss. The drug halted or slowed the progression of sensorineural hearing impairment in 63% of the patients with cochlear otosclerosis and 46% of the patients with stapedial otosclerosis. The single factor that best predicted which patients would respond most favorably to treatment was rate of progression before treatment. Sodium fluoride therapy was successful for 79% of the patients losing their hearing at a rate of 5 dB or more per year at one or more of the speech frequencies. The finding that patients with more rapid rates of progression responded most favorably to sodium fluoride therapy suggests that patients with the most active otospongiotic processes will be the most responsive to treatment.     

Argon laser assisted small fenestra stapedotomy for otosclerosis

To report and analyse our results and complications of argon laser assisted stapedotomy for primary otosclerosis. A retrospective analysis of 135 consecutive cases of primary otosclerosis operated by the senior author (JH) has been performed. The air-bone gap was calculated by using the pure tone average at 500, 1000, 2000 and 4000 Hz. A separate analysis of air-bone gap at 500, 1000 and 2000 Hz was carried out to assess the effects of a small diameter piston on low frequency hearing. Hearing at high frequencies (4000 and 8000 Hz) was also assessed to evaluate effects of small fenestra technique on high frequency hearing. Preservation of cochlear function was assessed by comparing the average pre- and post-operative bone conduction thresholds. Complications arising were analysed. The post-operative air-bone gap at 0.5, 1 and 2 kHz was 10 dB or less in 85.19% of patients and 20 dB or less in 97.04% patients. The air-bone gap at 0.5-4 kHz was 相似文献   

The effect of preoperative bone conduction threshold levels on the results of stapes surgery

The effect of preoperative bone conduction (BC) threshold levels on the results of stapedectomy was evaluated in 378 adult patients with otosclerosis. The mean follow-up period was 8.8 years. Both short-term and long-term postoperative hearing levels were found to be significantly dependent on preoperative BC levels. Only 2 of 31 patients (7%) with preoperative BC thresholds > 40 dB had postoperative hearing levels of 30 dB or better. However, hearing still improved by >_ 21 dB as often in patients with elevated preoperative BC thresholds as in patients with normal BC thresholds. These findings support the use of stapes surgery being worthwhile even in patients with highly elevated BC thresholds.