[Hearing loss following tympanic membrane injury].
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Audiometry, Pure-Tone↗
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Results for “Oval Window, Ear”
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Hyaluronate gel stapedotomy.
OBJECTIVE: To evaluate hearing results and postoperative dizziness after stapedotomy with application of sodium hyaluronate gel (HG) to the oval window niche during fenestration of the footplate. STUDY DESIGN: Case-control study comparing 27 stapedotomies with HG and 32 stapedotomies without HG. OUTCOME MEASURE: Preoperative and postoperative audiometric data, postoperative dizziness (vertigo or dysequilibrium), and nystagmus. RESULTS: Postoperative hearing results were not statistically different for the 2 groups. There were no cases of postoperative sensorineural hearing loss greater than 10 dB. Early postoperative dizziness (chi(2) = 4.08, P = 0.043) and nystagmus (chi(2) = 5.05, P = 0.024) were reduced in the HG group. CONCLUSIONS: HG stapedotomy is safe and effective and results in less early postoperative dizziness and nystagmus when compared with the standard technique of stapedotomy. The application of HG to the oval window niche to prevent blood from entering or perilymph from escaping the vestibule during fenestration of the stapes footplate may contribute to a quicker recovery in outpatient otosclerosis surgery.
Adjuvants, Immunologic↗
Anomalously coursing facial nerves above and below the oval window: three case reports.
Anomalous coursing of a dehiscent horizontal segment of the facial nerve, overlying or running below the oval window, is a rare phenomenon exclusively associated with conductive deafness caused by developmental abnormalities of the stapes and occasionally coincident with additional types of congenital auricular and nonauricular abnormalities. This article describes three new cases of this entity, including one previously unreported coincidence of an abnormally contracted tympanic ring, which should serve to alert the surgeon to the danger of surgical damage to a dehiscent, displaced facial nerve.
Adult↗
Imaging of the windows of the temporal bone.
Imaging of the window of the temporal bone has became an important tool in the analysis of hearing loss, vertigo, tinnitus in a context of trauma, malformation, otosclerosis, and chronic otitis media. A good knowledge of the anatomy and a good technical procedure are necessary for making an efficient diagnosis. The increased thickness of the footplate may be delineated in otosclerosis, chronic otitis media, malformation, when it is measured at 0.7 mm or more in horizontal computed tomography (CT) sections. The traumatic displacement of the stapes, particularly within the labyrinths, is easily diagnosed in horizontal CT section. Imaging of the round window is now very important for the detection of otosclerotic foci, congenital stenosis, and perilymphatic fistula with or without fracture. Magnetic resonance imaging (MRI) with the high-resolution T2 plays an important role in the detection of a small amount of fluid in the round window recess, confirming the traumatic perilymphatic fistula without fracture.
Deafness↗
Traumatic perilymphatic fistulae of the lateral semicircular canal.
Fifteen patients with perilymphatic fistulae were evaluated. Of these patients, three had CSF leaks in addition to the perilymphatic fistulae. Eight patients had fistulae of one or both windows; two had fistulae confined to the lateral semicircular canal; and two had combined fistulae of both round window and lateral semicircular canals. All improved dramatically following surgical repair. In the following study, we have shown that perilymphatic fistulae can occur in the lateral semicircular canal, and we suggest exploration of this area when indicated.
Adolescent↗
Round window reflex and oval window fistulae.
The round window reflex is normally absent in stapedial fixation. In this study, six cases of oval window fistula are described in which the round window reflex was absent. This is probably because there is insufficient pressure transmitted to the round window membrane through the perilymph because of leakage from the oval window. This is considered as an important diagnostic sign of oval window/stapes footplate ligament disruption.
Cochlea↗
The deep oval window.
This article presents the results of an analysis of the variable and surgically important relationship between the oval window, the fossular walls and the related posterior tympanic recesses in 50 temporal bones. The visual impressions of superficial and deep oval windows seem to correspond fairly closely to the depth of the inferior wall of the fossula fenestra vestibuli (FFV). The depth of the superior and anterior walls of the FFV by themselves, did not appear to have such a dominating relationship in determining the deep oval window. There does not appear to be a well defined posterior wall in the vast majority of the specimens (86 per cent). In the event of scar tissue forming between the superior, inferior and anterior walls, the gap between the postero-superior part of the promontory and the posterior tympanic wall (posterior communication) could allow aeration of the region of the deep oval window in such an instance. Closure of this gap by a solid shelf of ponticulus or scar tissue could cause a localized malaeration of the fossula in most cases of deep oval windows. This is an entirely new concept of the likely problems of malaeration of a deep oval window which could arise due to anatomical variations and of the possible safety valve mechanism which could prevent such malaeration and its consequences.
Humans↗
Locating the scala media in the fixed human temporal bone for therapeutic access: a preliminary study.
OBJECTIVE: To investigate the location of the scala media in relation to the round window niche in human temporal bones. DESIGN: Ten human temporal bones were investigated by radical mastoidectomy and promontory drill-out. SETTING: Temporal bone laboratory. OUTCOME MEASURES: The distance from the scala media to the anterior edge of the round window niche, measured by Fisch's stapedectomy measuring cylinders. RESULTS: The scala media was identified at the transection point of a vertical line 1.6 to 2.2 mm (mean=1.8 mm; standard deviation=0.2) anterior to the anterior edge of the round window niche and a horizontal line 0.2 mm inferior to the lower border of the oval window. CONCLUSION: This report demonstrates the point of entry into the scala media via the promontory in fixed temporal bone models, which may provide a site of entry for stem cells and gene therapy insertion.
Cochlear Duct↗
Adult onset spontaneous CSF otorrhea with oval window fistula and recurrent meningitis: MRI findings.
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Adult↗
Predilection of otosclerotic foci related to the bone turnover in the otic capsule.
Using multiple fluorochrome tagging of eight mongrel dogs and a newly established methodology of measuring bone turnover (BTO) in the otic capsule, it has previously been demonstrated that BTO in the canine otic capsule is highly reduced close to the perilymphatic spaces (PLS) compared to the normal level of BTO in the periphery. Reanalysis of these data shows that this inhibition of BTO is far more pronounced around the cochlea and vestibule than around the semicircular canals. Similar tendencies are seen for the numerical density and mean label area of the bone remodelling units. With increasing distance to the PLS, these patterns are weakened, but still recognizable. In otosclerosis, foci of abnormal bone deposition are particularly frequent around the oval and round windows and in the cochlear capsule, i.e. where inhibition of bone remodelling is most prominent. A surpassing (or failure) of this pronounced inhibition must precede the tumultuous but delimited osteogenesis of otosclerosis. Otosclerosis may be a deviation of the normal BTO process in an osteometabolically abnormal site, perhaps initiated as an osteogenetic response to abnormal stress exposure.
Animals↗
Surgical treatment of vertigo by utriculostomy: an experimental study in sheep.
The objective of this study was to develop and test an endolabyrinthic microsurgical procedure for treatment of vertigo, the utriculostomy. This involves the application of local heat for obtaining a fistula in the membranous labyrinth, so as to establish communication between the endolymphatic and perilymphatic spaces at the utricle level. Before the procedure, an experimental model using quail eggs was built for pre-evaluation, and macroscopic and histological studies were performed in the temporal bones of three healthy sheep. Following this, the utriculostomy was performed through the oval window in 12 sheep. A microthermocautery was conceived by the first author and developed at Hospital de Clinicas de Porto Alegre. This equipment allows for control of temperature and duration of exposure to heat. Three months after the surgery, the animals were killed. A histological study of the temporal bones was performed to assess whether communication had been created between the endolymphatic and perilymphatic spaces, or whether a neomembrane had developed in the cauterized region. Histological sections of the vestibule of eight animals (three normal, five surgical) were analysed. All non-surgical cases presented a normal utricle wall. Three surgical cases (60%) presented a neomembrane. The absence of identifiable perforations in the utricle wall and the presence of neomembrane areas in 60% of the operated bones suggest that utriculostomy is a promising procedure for the treatment of Meniere's disease.
Animals↗
Delayed onset hearing loss in a two-year old.
This paper describes a delayed onset sensorineural hearing loss in a baby known to have normal hearing until at least 13 months. A mild high-frequency loss was discovered quite by accident at 25 months. The bilaterally symmetrical loss progressed over the next 6 months to no measurable high-frequency hearing and a 70 dB threshold at 500 Hz. To our knowledge this is the youngest completely documented case of what has been called hereditary delayed onset hearing loss. However, in this instance, and perhaps unsuspected in others, this child had bilateral oval and round window fistulas whose repair may have not only arrested the progression of her loss, but even improved her residual hearing sensitivity.
Audiometry↗
Revision stapes surgery: the malleus to oval window wire-piston technique.
OBJECTIVE: To determine the effectiveness of the malleus to oval window wire-piston revision stapes surgery technique. STUDY DESIGN: A retrospective analysis of 243 stapes procedures performed by the senior author over a 10-year period identified 15 revisions. Five patients underwent a malleus to oval window wire-piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted. METHODS: Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire-piston prosthesis. RESULTS: Among revision stapes procedures, there was no significant difference in the air-bone gap closure or complication rate between the incus to oval window and the malleus to oval window techniques. The average preoperative air-bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss. CONCLUSIONS: In experienced hands, revision stapes surgery using the malleus to oval window stapes wire-piston prosthesis is safe and effective.
Adult↗
Partial promontory technique in stapedotomy cases with narrow niche.
OBJECTIVE: The objective of this study was to examine clinical and audiometric outcomes of a laser partial promontory technique in stapedotomy cases with a narrow oval window niche. STUDY DESIGN: We conducted a retrospective chart review. SETTING: This study was conducted at a tertiary referral center. PATIENTS: We studied 59 patients who underwent a partial promontory technique with stapedotomy between 1994 and 2000. Seventy-two patients who underwent primary stapedotomy without promontory technique served as a control group. METHODS: Preoperative and postoperative audiometric results were obtained for 59 patients undergoing laser stapedotomy with a narrow oval window niche. The partial promontory removal was performed with a KTP laser. Results were compared with 72 primary laser stapedotomy cases without the promontory technique within the same time period and analyzed using paired Student t test. RESULTS: Ninety percent of the partial promontory cases were successful (air-bone gap [ABG] <10 dB). The mean postoperative ABG was 5.1 dB, which was comparable to the non-promontory cases (p = 0.7). The mean change in postoperative bone conduction was also comparable (p = 0.98). There were no cases of sensorineural hearing loss. An overhanging facial nerve was present in 32% of the narrow niche cases and a dehiscent facial nerve was encountered in 17% of these cases. CONCLUSIONS: Partial laser removal of the promontory as an adjunct to laser stapedotomy cases with a narrow oval window niche is a safe, effective technique with comparable results to primary laser stapedotomy.
Adolescent↗
Congenital bilateral oval and round window aplasia with a hypoplastic stapes.
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Adolescent↗
Success rate in revision stapes surgery for otosclerosis.
OBJECTIVE: The aim of this study was to evaluate the hearing results of revision stapes surgery performed because of previously failed operations and to determine the causes of failure. STUDY DESIGN: Retrospective review of revision stapes operations. SETTING: Tertiary referral center. PATIENTS: Sixty-three consecutive revision stapes operations were performed in 56 patients over a period of 12 years (1992-2004). The indication for revision surgery was recurrent or persistent air-bone gap greater than 20 dB after primary surgical treatment of otosclerosis of the oval window. RESULTS: All patients were operated on to improve hearing. Sixty-three revision stapes operations resulted in closure of the air-bone gap to 10 dB or less in 52.4% of cases. The average postoperative air-bone gap was 13.1 dB, and the mean pure-tone average improvement was 12.9 dB. In six patients (9.5%), revision surgery produced no change in hearing, and in four (6.3%) the hearing decreased by 5 dB or more. In one patient, the operation resulted in a profound hearing loss. Prosthesis malfunction was the most common primary cause of failure (60.3%). The original prosthesis was replaced with a new one in 48 cases. In 30 of these (62.5%), closure of the air-bone gap to within 10 dB was achieved. In 15 cases, the prosthesis was not replaced, and in only four of these (26.7%), closure of the air-bone gap within 10 dB was obtained (p < 0.022). CONCLUSION: Revision stapes surgery is less likely to be successful than the primary operation. Closure of the air-bone gap to within 10 dB was achieved in 52.4% of patients. The success rate was better in cases where the original prosthesis was replaced with a new one. The risk for decreased bone-conduction threshold does not seem to be higher than in primary surgery.
Adolescent↗
Promontory drilling in stapedectomy: an anatomical study.
BACKGROUND: Anatomical variants such as an overhanging facial nerve or promontory can impede access to the footplate during stapedectomy. Drilling away bone from the cochlear promontory may be required. In the case of a floating or depressed footplate, it has been recommended that a "pothole" be drilled in the inferior margin of the oval window. There is little published information on the anatomy of the promontory with respect to these maneuvers. MATERIALS AND METHODS: Twenty temporal bones were studied. A series of measurements was made to assess how much bone may safely be removed without risking damage to the underlying cochlear endosteum and, hence, spiral ligament and stria vascularis. RESULTS: The bony promontory is thickest posteriorly, and here, the endosteum has least lateral projection. The promontory becomes thinner closer to the oval window. Moving anteriorly, the bone becomes thinner and the underlying endo steum more closely follows the bony contour. The stria vascularis and spiral ligament may be less than 0.2 mm inferior to the inferior margin of the oval window posteriorly. This distance is at least 0.3 mm at the midpoint of the footplate (range, 0.3-0.5 mm). CONCLUSION: Bone may be removed inferiorly to the posterior one-third of the footplate from lateral to a line that makes an angle of 35 degrees with the superoinferior axis of the footplate. In creating a "pothole" in the case of a floating or depressed footplate, the authors recommend that it be created at the midpoint of the inferior margin of the oval window and should not exceed 0.3 mm in diameter.
Facial Nerve↗
Perilymph fistulae.
A small series of 14 post-stapedectomy fistulae illustrates the varied aetiology. The long-term competence of the oval window seal may be ensured by making a small hole in the footplate. Contraction of ageing fibrous tissue contributes to late stapedectomy failures. Long-term follow-up is important, for any deterioration in hearing after stapedectomy may result from a perilymph leak.
Female↗