Biomedical subjects
J B Causse
Publications and source records attributed to J B Causse.
Stapedius tendon reconstruction during stapedotomy: technique and results.
During surgery for otosclerosis, it is common for the surgeon to cut the stapedius tendon. Even without reconstruction of the tendon, the results of this kind of surgery are particularly satisfactory. The stapedial reflex is more important for improving intelligibility of speech in the presence of background noise than for protection against hazardous levels of noise. An intact stapedial reflex improves ones ability to follow speech in the presence of background noise. This report will present a technique to reconstruct the stapedius tendon, along with the results obtained when adding this procedure to stapedotomy surgery.
Argon laser and Gherini-Causse Endo-Otoprobe in otologic surgery.
The authors describe the various surgical indications and techniques of the argon laser and Gherini-Causse Endo-Otoprobe in otologic surgery, from otosclerosis to chronic otitis. The advantages are numerous, permitting the surgeon to vaporize or coagulate tissue with optimal effect, avoiding excessive mobilization of the ossicular chain and diminishing the risk of damage to the facial nerve and inner ear structures.
Poor vibration of inner ear fluids as a cause of low tone tinnitus.
Tinnitus due to otosclerosis may be caused by poor vibration of the inner ear fluids. The goal of this article is to suggest some explanations, to enhance future research work carried out by other authors on this important issue, and to show what are the results of surgery to relieve tinnitus in the author's experience. Only complete resolution of the tinnitus 1 year after surgery was taken into account in the assessment of the results.
Ossiculoplasty with composite prostheses. Overview and analysis.
Aeration of a mucosa-lined tympanic cavity is essential for a functioning middle ear. Extrusions of even the best-designed prostheses occur from abnormal middle ear conditions such as atelectasis, middle ear fibrosis, recurrent cholesteatoma, tympanic membrane perforation, and otitis media. Various polymers have been developed in an attempt to maximize prosthetic biocompatibility and ease of use while minimizing the chance of extrusion. One such polymer is a composite of hydroxyapatite and Silastic, known as Flex H/A. This material has been incorporated into two ossicular prostheses, the Universal Plus and the Causse Flex H/A prostheses. Certainly, refinements will continue to be made in the chemical makeup of the bioceramics in order to achieve optimal biocompatibility. In addition to biocompatibility, cost containment issues have influenced the development of ossicular prostheses. A universal prosthesis eliminates the need to stock multiple designs, thereby reducing the cost to institutions. One of the greatest challenges in the future will be to define the appropriate prosthetic design for optimal sound transmission. Consideration of prosthesis weight, head size, and footplate attachment are future research questions that need to be addressed in a scientific biologic model.
Sodium fluoride therapy.
As a medical treatment for otospongiosis-otosclerosis, sodium fluoride influences the underlying bony changes in the labyrinth so as to arrest or prevent the onset of hearing loss. Sodium fluoride is an enzyme inhibitor and reduces osteoclastic bone resorption and, if the dosage is more than 60 mg a day, may rebuild pseudohaversian bone.
Impedance transfer: acoustic impedance of the annular ligament and stapedial tendon reconstruction in otosclerosis surgery.
The resistance rebuilt around the lower tip of the piston must be the same as that created by the annular ligament of the stapes footplate. Otherwise, the threshold at which an acoustic or barotrauma is able to damage the membranes and hair cells of the inner ear will be lowered. The elasticity reestablished around the lower tip of the piston plays a part in the quality and quantity of hearing for the low frequencies up to 3 kHz. To protect the ear against acoustic traumas, an attempt to rebuild the stapedial reflex is proposed.
Surgical treatment of stapes fixation by fiberoptic argon laser stapedotomy with reconstruction of the annular ligament.
The goal of surgical treatment of stapes fixation is to restore the impedance transfer of the ossicular chain and the acoustic impedance of the annular ligament of the stapes footplate to achieve normal physiologic vibration of the inner ear fluids. Advances in instrumentation, particularly the introduction of fiberoptic laser handpieces and microdrills, have enabled surgeons to approach this goal in a more precise and delicate fashion. In this article, the authors review their surgical techniques, the biophysics involved, the physics of fiberoptic handpieces for the delivery of argon laser energy, and their results.
Fiberoptic argon laser stapedotomy: is it safe?
The history of otosclerosis surgery has been marked by major advances in both surgical technique and instrumentation. Fenestration, stapes mobilization, total stapedectomy, and stapedotomy were important advances in technique. Loupes, binocular microscopy, speculum holders, and microdrills similarly advanced instrumentation. What about fiberoptic argon laser handpieces for use in laser stapedotomy? Do they represent a significant advance in instrumentation, or are they merely another gimmick? Are fiberoptic argon laser handpieces safe? Experimentally, the thermal effects of argon laser, delivered via fiberoptic handpieces to a cadaver stapes and model vestibule, were studied. No significant temperature elevations within a model vestibule were observed during stapedotomy. There were significant temperature elevations within the laser plume at the level of the facial nerve. These findings are consistent with our experience in over 2200 primary and revision stapedotomies. To date, there have been no cases of significant hearing loss or permanent facial paralysis related to the use of these fiberoptic handpieces. We believe fiberoptic argon laser handpieces are as safe as conventional microsurgical instruments in stapes surgery.
Survival and evolution of vein grafts in otosclerosis surgery: structural and ultrastructural evidence.
The annular ligament of the stapes footplate measures 0.2 mm2 and contains elastic fibers that restrict perilymphatic movement to a molecular level. This resistance of the annular ligament prevents excessive movement of labyrinthine fluids that are potentially hazardous to the membranous and cellular structures of the inner ear. However, if the resistance of the annular ligament is overcome, then inner ear damage can occur. The vein graft, as used in our technique for otosclerosis surgery, occupies a space of 0.2 mm2 between the edge of the stapedotomy hole and the piston and has nearly the same compliance and resistance as the annular ligament of the stapes footplate. The vein graft becomes integrated with the middle-ear mucosa. It develops a rich and active blood supply and the smooth muscle cells and elastic fibers remain, although the latter show some modification of ultrastructural pattern. The graft becomes overlaid by the middle-ear epithelium. Even samples of vein graft that have been present for many years retain surviving elastic fibers, including those that have become fibrotic. In time, the number of elastic fibers increases as a result of the activity of fibroblasts, which build a poorly colored collagen.
[Multi-electrode extra-cochlear implants].
From july 1987 through july 1989, we have performed eight extra-cochlear implants for the rehabilitation of bilateral total deafness. In this paper we develop this experience, to give the positive aspects but also the negative ones and we give the reasons why we prefer currently the intra-cochlear implant. However this implant and its method are a good solution in case of an ossified cochlea.
Stapedotomy: the JB Causse technique.
The Jean-Bernard Causse technique of stapedotomy, derived from Jean René Causse "Teflon-interposition" technique, offers an optimum reconstitution of the function of the annular ligament of the stapes footplate. The quantity and quality of hearing depend significantly, among other things, on the function of the stapes footplate annular ligament. Its impedance keeps the perilymph motion within a physiological acoustic amplitude quantum level unless the movements are so excessive as in barotrauma and acoustic trauma which would have overworked even the annular ligament of a normal footplate. This surgical technique permits snorkling, scuba-diving, airplane landing, eustachian tube dysfunction after surgery as in a normal individual who did not undergo otosclerosis surgery. A comparative study on the postoperative hearing based on 3,000 out of 14,000 cases done by J C Bausse technique, 127 cases with small fenestra technique and 267 cases of complete platinectomy showed too large stapedotomy gives poor high tones and too small stapedotomy poor low tones. Five year follow-up on the hearing loss indicated that total platinoctomy has 1.7 times more alteration of 4 kHz frequency in comparison to the technique reconstituting the annular ligament. Yearly audiogram to check the evolution of cochlear otospongiosis may lead the surgeon to prescribe sodium fluoride if the mid-frequencies are deteriorating and vascular drugs if the high pitch frequencies are deteriorating.
[Subcophosis and otosclerosis. Medical and surgical treatment].
The spiral ligament of the stria vascularis is nearly always damaged by otosclerotic foci when the patient is nearly totally deaf because of otosclerosis. Vascular drugs are to be prescribed in such a case, besides the Sodium Fluoride treatment. The Sodium Fluoride is, according to us, the best treatment to arrest the progression of the otosclerotic disease. Sodium fluoride will destroy the proteolytic enzymes damaging the inner ear membranes and the hair of the Corti hair cells.
[Gherini-Causse endo otoprobe and HGM argon laser. Value in the surgery of ear abnormalities].
Performing a stapedectomy in a slightly fixed otosclerotic footplate may induce an excessive motion of the labyrinthine fluids, damaging inner ear membranes and Corti hair cells fragilized by proteolytic enzymes. The fluid motion in the cochlear canal is quantic size only. The replacement of a slightly fixed footplate by an ideal compliance and impedance transmitting device, may allow the surgeon to get a tremendous improvement of hearing (as a Meniere disease). The Gherini-Causse multi-use endo-otoprobe combined with a HGM Argon Laser, if associated with a Skeeter Oto-tool drill, looks to be an efficient and safe solution to this otologic surgical challenge.
The twenty fine points of otosclerosis surgery.
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Etiology of otospongiotic sensorineural losses.
The etiology of otospongiotic-otosclerotic disease is enzymatic; the proteolytic enzymes released by the otospongiotic-otosclerotic foci damage the inner ear and are also the basis of the bony rebuilding of the OW niche leading to stapedial fixation. The trigger may be an autoimmune process due to the reaction of the enchondral otic capsule against the embryonic cartilaginous remnants, genetically determined to be located in the otic capsule and mainly in the fissula antefenestram.
Vertigo in postoperative follow-up of otosclerosis.
Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.
[Sound injuries after surgery of otosclerosis].
Surgery for otosclerosis means that the sound protection due to the fixation of the footplate does not exist anymore. As the Corti hair cells have been fragilized by proteolytic enzymes, it is absolutely necessary to reconstruct the sound mechanism in order to maintain the vibration of the perilymph absolutely within acoustical physiologic limit of movement. The means to realize this reconstruction are presented in this paper, as well as the results.