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PubMed1994

Small fenestra stapedotomy for management of progressive conductive deafness.

Progressive conductive deafness may be caused by otosclerosis, a bone fixation of the stapes that causes reduced transmission of sound from the eardrum to the inner ear. Since the late 1950s, stapes surgery has been considered the treatment of choice for alleviating hearing loss due to otosclerosis. Over the past 20 years, there has been a decline in the number of stapes operations done. As a result, there are concerns regarding results of the stapes surgery done today compared with the results of such surgery when it was done more frequently. In this paper, I retrospectively review 603 stapes operations that I did at the Farrior Ear Clinic between 1981 and 1991. There were 484 primary stapes operations. Hearing results using the small fenestra technique showed closure of the air-bone gap to 10 dB or less in 96% of cases. During the same period, 119 revision operations were also done. The surgical technique, operative findings, and hearing results are presented. In both primary and revision stapes surgery, the hearing results of this series are compatible with the results of earlier, larger series. My findings show that stapes surgery is still the treatment of choice for hearing loss due to otosclerosis.

Adolescent↗

PubMed2003

Retrospective analysis of early postoperative hearing results obtained after stapedotomy with implantation of a new titanium stapes prosthesis.

OBJECTIVE: To evaluate the early postoperative hearing results of a new titanium stapes prosthesis (K-Piston) implanted in patients with otosclerosis. STUDY DESIGN: A retrospective analysis of preoperative and early postoperative hearing thresholds. SETTING: One tertiary referral and teaching hospital. PATIENTS: Eighteen men and 40 women, mean age 47 years, with otosclerosis. INTERVENTION: Primary stapedotomy. MAIN OUTCOME MEASURE: Main outcome measures were the mean gains in bone-conduction and air-conduction pure-tone thresholds, and pure-tone averages for different frequency combinations. Success and failure of the individual cases were presented using Amsterdam Hearing Evaluation Plots. RESULTS: The overall postoperative air-bone gap for the frequency combination 0.5-1-2-4 kHz was 8.4 (standard deviation: 5.2) dB. In 79% of the patients the postoperative air-bone gap was less than 10 dB. Air-conduction improved even in higher frequencies, while the Carhart effect was not seen in most cases. In three patients a deterioration of bone-conduction was observed ranging from 11 to 16 dB sound pressure level (SPL), and in four patients the gain in air-conduction was insufficient (3-29 dB SPL) to close the preoperative air-bone gap to within 20 dB. CONCLUSION: The new low-weight, full-titanium stapes prosthesis with its slight rough surface and its good mechanical stability and biocompatibility can safely and successfully restore the function of the middle ear when implanted in patients with otosclerosis.

Adult↗

PubMed2007

Influence of chronic middle ear diseases on gustatory function: an electrogustometric study.

OBJECTIVE: We aimed to quantitatively determine whether middle ear inflammation associated with unilateral chronic otitis media (COM), cholesteatoma, or otosclerosis affects gustatory function. STUDY DESIGN: Prospective study. SETTING: University Hospital, Department of Otolaryngology. PATIENTS: Forty-two patients had unilateral COM (22 men, 20 women; mean age, 54.2 yr), 57 had unilateral cholesteatoma (35 men, 22 women; mean age, 42.1 yr), and 19 had unilateral otosclerosis (10 men, 9 women; mean age, 49.3 yr). MAIN OUTCOME MEASURES: Patients underwent taste testing using electrogustometry (EGM) and sensation thresholds were compared in the affected and unaffected ears among groups and between affected and unaffected ears in each group. RESULTS: Patients with COM and cholesteatoma exhibited an increase in taste threshold in the affected ears compared to the unaffected ears (p < 0.05), whereas otosclerosis patients did not. The extent of the increase of the sensation thresholds in the affected ears was very similar between patients with COM and those with cholesteatoma (p = 0.548). CONCLUSION: Our EGM study showed that cholesteatoma and chronic middle ear inflammation affected gustatory function to a similar degree.

Adult↗

PubMed2005

Prospective clinical study on cochlear function after erbium:yttrium-aluminum-garnet laser stapedotomy.

OBJECTIVE: To assess whether the application of the emitting erbium:yttrium-aluminum-garnet (Er:YAG) laser in stapedotomy has negative effects on vestibular and cochlear functions. DESIGN: Prospective, with 12 to 14 months follow-up. SETTING: Academic tertiary referral center. PATIENTS: Twenty-four patients undergoing stapedotomy (primary surgery) in otosclerosis. INTERVENTION: All patients underwent Er:YAG laser-assisted stapedotomy for otosclerosis between January 2000 and June 2002. MAIN OUTCOME MEASURES: Early (1-3 days after surgery) and late (12-14 months after surgery) postoperative bone-conduction thresholds and the presence of post-operative tinnitus and vertigo were analyzed. In addition, the relation between applied laser energy and postoperative bone-conduction thresholds was calculated. RESULTS: In 22 patients, unchanged preoperative minus early postoperative pure-tone bone-conduction averages at 1, 2, and 4 kHz were observed. In one patient, a slight early deterioration between 10 and 20 dB was seen. In 18 patients, unchanged preoperative minus late postoperative pure-tone bone-conduction averages at 1, 2, and 4 kHz were observed. In two patients, a slight late deterioration between 10 and 20 dB was seen. In two patients, a new postoperative tinnitus was observed. No patient suffered from vertigo at the time of second evaluation. No correlation between applied laser energy and both postoperative bone-conduction thresholds was found. CONCLUSIONS: The Er:YAG laser stapedotomy in otosclerosis is a safe technique. Vestibular and cochlear function is not significantly disturbed after Er:YAG laser stapedotomy.

Adult↗

PubMed1982

A note on progression of the otosclerotic focus.

One thousand and thirteen consecutive patients in South Australia with stapedial fixation from otosclerosis were classified by duration of deafness, age at onset and degree of footplate pathology to determine whether there is an orderly progression in severity of the oval window lesion with duration of symptoms. The conclusions drawn were as follows. (1) An early age of onset of clinical otosclerosis, during the period of skeletal growth, dramatically increases the chance of contracting a fulminating lesion with severe and diffuse involvement of the stapedial footplate or obliteration of the oval window niche. (2) A late age of onset of clinical otosclerosis tends to be associated with lesions of the stapes footplate that are limited to the anterior pole, and there is good evidence that the lesion tends to remain stable or to progress only very slowly. (3) The case for a regular and orderly pathological progression of the otosclerotic lesion through various patterns of severity from minor to major degrees of footplate pathology is not established by the data; nor is it convincingly refuted. It is clear that if a pathological progression of the lesion does take place it must be at vastly different rates for different individuals.

Adolescent↗

PubMed1992

The prevalence of middle ear disease in the adult British population.

The UK National Study of Hearing set out to ascertain the prevalence of hearing impairments of various magnitudes, the prevalence of ear disease and the associated risk factors, and to estimate the percentage of individuals requiring some form of management. A stratified sample of 2708 British adults, aged 18-80 years, was chosen from a sample of 48,313 adults, randomly selected from the electoral roll, for a full otological and audiological assessment. This paper deals primarily with the middle ear results. Otoscopically, 2.6% of British adults had inactive and 1.5% had active chronic otitis media. This condition was more common in older individuals and in those in manual occupations. For this purpose, presumptive otosclerosis was defined as a conductive component to the impairment (average air bone gap over 0.5, 1 and 2 kHz of 15 dB or greater) and with an intact tympanic membrane. The population prevalence for presumptive otosclerosis was 2.1%, for healed OM 1.7% and for Eustachian tube dysfunction 0.9%. This prevalence of otosclerosis was higher in those over 40 years, but only in those with air bone gaps of 30 dB or greater were women more likely to have the condition than men, by a factor of three. At most, 20% of individuals with any of the above middle ear conditions will have had ear surgery.

Adult↗

PubMed1990

Otic capsule bony lesions in the Palmerston North autoimmune mouse.

Otosclerosis is an otic capsule disorder of unknown etiology. While autoimmunity has been proposed as part of the etiopathogenesis of otosclerosis, no spontaneous autoimmune disease animal model has been identified. In the Palmerston North mouse, a model for systemic lupus erythematosus, sclerotic lesions consistently develop within the modiolus that are correlated with systemic autoimmune disease symptoms. No lesions were seen in 2-month-old mice, which is before autoimmune disease onset at 4 months. Lesions were first seen in mice at 6 to 8 months of age and increased in size and frequency thereafter. By 20 months, all ears examined had the otic capsule lesions, which were primarily perivascular in location and composed of both noncellular and cellular elements. The noncellular material was globular to fibrillar in arrangement and stained positively for calcium. The associated cells appeared to be metabolically active fibroblasts. It is proposed that the Palmerston North mouse may serve as a model to further investigate the role of autoimmunity in otosclerosis and other forms of otic capsule osteogenesis.

Animals↗

PubMed2000

Meningitis following stapedotomy: a rare and early complication.

Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.

Adult↗

PubMed2006

Hearing improvement after stapedotomy using teflon loop prosthesis.

OBJECTIVE: To assess hearing improvement after stapedotomy for otosclerosis using teflon loop prosthesis. DESIGN: Quasy experimental study. PLACE AND DURATION OF STUDY: January 2001 to May 2003 in the Otorhinolaryngology Department, CMH, Rawalpindi. PATIENTS AND METHODS: Thirty diagnosed cases of otosclerosis were included in the study. Ear with greater air-bone gap was selected and stapedotomy was done using teflon loop prosthesis (size 4 - 4.5 mm). Mild vertigo occurred during immediate postoperative period, which subsided with Inj. Prochlorperazine. Patients were followed-up postsurgically at one month, two months, four months, six months and one year and postoperative air-bone gap was calculated. RESULTS: Out of 30 cases, there were 24 males and 06 females. The age ranged from 18 to 50 years. Twenty-one (70%) patients had bilateral hearing loss and 09 (30%) had tinnitis also. Pre-operative audiograms showed conductive deafness. Carhart's notch was present in 10 (33.3%) cases. Tympanogram revealed loss of stapedial reflex. Postoperatively good hearing improvement was seen in 56.7% (postoperative air-bone gap closure upto 10 dB), fair improvement in 30% (postoperative air bone gap closure from 11 to 20 dB) and poor results in 10% (postoperative air-bone gap more than 21 dB) cases. One patient developed dead ear. CONCLUSION: Stapedotomy using teflon loop prosthesis for otosclerosis is an effective method to restore hearing. Complications are uncommon.

Adolescent↗

PubMedDate not supplied

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.

Acoustic Stimulation↗

PubMedDate not supplied

Psychoacoustical tuning curves in audiology.

The correlation between classic masking patterns and psychoacoustical tuning curves is discussed quantitatively. A simplified method to measure such tuning curves in clinical use is described. They are shown to be insensitive to the frequency dependence of the hearing loss. Tuning curve data of six different groups including normal and hard-or-hearing observers are given: normal hearing, conductive hearing loss, degenerative hearing loss, noise-induced hearing loss, otosclerosis and Menière's disease. The resulting tuning curve data indicate that the frequency resolving power of the four groups mentioned last is greatley reduced but not completely absent, especially in the range of greater hearing loss. The correspondence between the frequency-resolving power measured by the tuning curve method and the result of speech discrimination tests is demonstrated. The measured data indicate that more than 50% of the patients with otosclerosis show reduced frequency selectivity although otosclerosis is commonly regarded as a conductive hearing loss.

Acoustic Stimulation↗

PubMed1976

[The genetics of the protease inhibitor system and osteospongiosis. Statistical study in 199 patients].

Since the trypsin activity of the inner ear fluid appears to be essential in the evolution of otosclerosis towards a cochlear deafness it was obvious that the protease inhibitor system which is an excellent genetic marker ought to be studied during the onset and the evolution of otosclerosis. No differences with the statistical data from the normal population was found the origin of the trypsin that destroys the inner ear is to be found locally the histiocytes of the otosclerosis focus.

Ear, Middle↗

PubMed1992

Stapedectomy versus stapedotomy: a comparison.

Two hundred and fifty consecutively operated stapes procedures operated by the author for otosclerosis are presented. A fat-wire stapedectomy prostheses (Schuknecht) was used in 152 cases and a Fisch teflon-wire piston was used in 98 ears. Of the 250 procedures 33 patients had bilateral surgery. The operations were done in local anaesthesia in most cases and with endomeatal incision. The fat-wire prostheses gave in 95% a closure within 10 dB and the rest 5% closed within 11-20 dB. The Fisch teflon-wire piston gave a closure within 10 dB in 87%, within 11-20 dB in 12% and within 21-30 dB in 1%. The speech reception was better after operation in 97% of patients operated with the fat-wire prostheses and in 99% of patients having the teflon-wire piston. It was a significant difference at 20 dB level of speech improvement (p < 02) in favour of the teflon-wire piston. The surgery for otosclerosis is a special procedure seeking refinements in surgical techniques to increase safety and maintain acceptable results. Our results show that the small fenestra technique with 4 mm piston will give better speech reception and better hearing in the high frequencies. To achieve a high standard the operations for otosclerosis should probably be centralised to let the surgeon do a minimum of 8 to 10 procedures every year.

Humans↗

PubMed1988

Stapedotomy with and without stapedius tendon preservation versus stapedectomy: long-term results.

Stapedectomy and stapedotomy are presently the techniques utilized in the surgical treatment of otosclerosis. The technique of choice at the ENT Department of the University of Verona has changed from stapedectomy to stapedotomy with and without stapedius tendon preservation. From January 1975 to December 1985, 805 ears were operated on for otosclerosis at our department. A statistical analysis has been performed on three groups of patients (stapedectomy, stapedotomy without and with stapedius tendon preservation) at short and long term. The results suggest that stapedotomy with stapedius tendon preservation should be the preferred surgery in the treatment of otosclerosis.

Adolescent↗

PubMedDate not supplied

Ossicular and otic capsular lesions in LP/J mice.

Otosclerosis is an inherited disease in which abnormal bone growth results in ossicular fixation and hearing loss. Although the disease affects up to 10% of humans, it has not been observed in other animals. The LP/J inbred mouse has been found to develop abnormal bony lesions of the middle ear which resemble human otosclerosis. In this study of 113 temporal bones from LP/J mice, we found that the lesions develop after puberty and involve only the ossicles and the otic capsule. The most frequent site of involvement was the incus (46.9%), followed by the anterior crus of the stapes (31.3%), the malleus (14.2%), the otic capsule (14.2%), and the stapes footplate (8%). Cochlear hair cell loss was progressive throughout the lifespan of these animals. Although this disease is not identical in histologic appearance to human otosclerosis, understanding its disease process may shed light upon the pathophysiology of the human disease.

Animals↗

PubMedDate not supplied

[The significance of genetic markers in otosclerotic hearing loss].

Phenotypes HLA-A, HLA-B and HLA-C were determined in 85 patients with otosclerosis verified at surgery and in 113 clinically healthy subjects. The patients were divided into 2 groups: with family predisposition to otosclerosis (13 subjects) and without such (72 subjects). A tendency was established to more frequent occurrence of antigens A2, B12 versus less frequent of antigens B27, B40, Cw1 in patients compared to controls. It is concluded that at least one of the genes determining the resistance to otosclerosis exists in the HLA region, in binding groups B27, B40 and Cw1. It is suggested that genes predisposing to the disease (A2, B12) may be located at the same place.

Adult↗

PubMed1991

Correlation between antibodies to type II collagen and treatment outcome in bilateral progressive sensorineural hearing loss.

Our aim was to assess whether "idiopathic" bilateral progressive sensorineural hearing loss (BPSHL) has an immunological cause in some patients; antibodies to native type II collagen were sought by an ELISA in eighteen patients with BPSHL, before and after corticosteroid treatment, and in twelve patients with Menière's disease, fifteen with otosclerosis, eighteen with rheumatoid arthritis, nine with fibrositis, and nine healthy controls. A positive result was defined as a mean dilution titre of 2 or more. Eight of eighteen BPSHL patients had positive titres--significantly (p less than 0.005) more than in any other group (one Menière's disease, two otosclerosis, and no others). The mean antibody titre was higher in the BPSHL group than in any other group (2.02 [SEM 0.62] vs 0.17 [0.17]) Menière's disease, 0.44 [0.32] otosclerosis, 0 all others; p less than 0.005). The nine BPSHL patients who showed a clinical response to corticosteroids (improvement in at least one tone by audiogram or 25 db in speech discrimination score) had the highest mean antibody titre (3.46 [0.88] vs 0.59 [0.59] for the nine non-responsive patients; p less than 0.04). We suggest that in some patients with BPSHL, immunity to type II collagen, a major constituent of the inner ear, may be important in the pathogenesis of the disorder.

Antibodies↗

PubMed1999

Modelling surface potentials from intracochlear electrical stimulation.

Volume conduction models were used qualitatively to model surface potentials from cochlear implant patients recorded earlier by the authors. These recorded potentials reflected the equivalent dipole orientation in the head in patients who are deaf due to otosclerosis, but increased uniformly with the distance between the stimulating electrodes along the basilar membrane in other patients, which suggested a low and high resistivity of the cochlear bone, respectively. Several models of the head were constructed, with compartments representing the skin, skull, brain, cochlea, internal and external ear canal. In the "petrous bone" model, the cochlea was modelled as a cavity in a bony layer surrounded by the brain compartment. Of all models, the petrous bone model using a high resistivity ratio (1:100) between the bony and the other compartments was the only one that produced outcomes similar to the potentials observed in non-otosclerosis patients. In conclusion, the results suggested that the surface potentials observed in non-otosclerosis patients are sufficiently explained by a high impedance between cochlear turns and a non-specific return of current via the wall of the petrous bone into the larger brain compartment.

Cochlea↗