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Results for “STAPES SURGERY”
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X-linked progressive mixed deafness with perilymphatic gusher during stapes surgery.
Stapes gusher is a rare and usually unexpected complication of stapes surgery. This complication will inevitably be encountered during stapes surgery in all affected males with the X-linked, progressive mixed deafness syndrome. The opportunity of studying eight affected males in a large Dutch family with audiometry, vestibulometry, and polytomography was used to identify specific features. Awareness of these features will assist the otologist in recognizing new cases preoperatively.
[Improved total results in stapes surgery by stapes plastic surgery (interposition)].
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[Repeated surgery after stapes surgery in otosclerosis].
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Delayed vertigo after stapes surgery.
OBJECTIVES: Stapes surgery restores partial or total hearing in almost 95% of cases, and in case of failure, revision surgery may often resolve the problem. Delayed vertigo is commonly related to perilymphatic fistula. The aim of this study is to report experience gained in revision stapes surgery in cases of delayed vertigo. STUDY DESIGN: This is an intervention study, before-after trial; it includes follow-up between 12 and 84 months that was based on clinical history and audiometric evaluations. METHODS: The work was carried out in the otologic surgery referral center of Piemonte in outpatient surgery. Nine patients (4 males and 5 females, between 43 and 60 years of age) who presented with delayed vertigo after stapes surgery were retrospectively reviewed. All nine underwent clinical history evaluation, pure tone audiogram, investigation of the vestibular system with a bithermal binaural caloric test, and fistula test. Vestibular tests were performed with electronystagmography recording. In all nine subjects, functional middle ear exploration was carried out by way of a transmeatal approach using local anesthesia. The demonstration of a perilymphatic leak was positive in only three (33%) cases, but the oval window region was filled with fibrin glue in all nine cases. RESULTS: At follow-up, vertigo was resolved in all cases with revision surgery, even though perilymph leak was positive only in three cases. CONCLUSION: From the results obtained, we feel that exploration of the middle ear should be always carried out in cases of delayed vertigo after stapes surgery with suspected perilymphatic fistula.
[Clinical and experimental studies on stapes surgery. 1. Clinical results of stapes surgery in our department].
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The learning curve in stapes surgery.
Fewer stapes operations are available to train residents and to maintain individual competence. Most residents in the United States perform 0 to 10 cases during training, and produce results which are not as good as expert results, even with close supervision. After graduation, fewer cases are available to achieve expert results in private or academic practice. The authors' conclusions and recommendations are based on his own learning curve. Residents who have below average skills in middle ear surgery, and residents who do not wish to practice otology, should watch but not perform stapes surgery. Program directors, collectively or separately, should develop more formal guidelines for teaching stapes surgery during residency.
Revision stapes surgery.
With the decline in primary cases of otosclerosis surgery, revision stapes operations are becoming a higher percentage of otosclerosis practice. Are the results from revision stapes surgery today comparable with those of surgeons trained prior to the present decline? A retrospective review of 559 consecutive stapes operations performed by the author revealed 109 revision operations. A retrospective review of these cases reveals that the most common cause for revision surgery was displaced prostheses and incus necrosis. The hearing results are dependent on the surgical pathology. In this series, the airborne gap was closed to less than 10 dB in 58% of cases, there were 64% of cases of displaced prostheses, and 57% of cases of incus necrosis, which is comparable with previously reported studies.
Transient evoked and distortion product otoacoustic emissions following successful stapes surgery.
BACKGROUND: The effect of stapes surgery on the recording of otoacoustic emissions is unknown. The aim of the present study was to evaluate the success of stapes surgery by using acoustically evoked otoacoustic emissions as an objective and fast method for postoperative hearing evaluation. METHODS: Transient evoked (TEOAE) and distortion product otoacoustic emissions (DPOAE) were measured consecutively in otosclerosis patients before as well as 3 and 6 months after stapes surgery. RESULTS: Air-bone gaps in the pure-tone audiograms were significantly reduced in all patients. TEOAEs and DPOAEs were not measurable preoperatively and were only evident in one patient postoperatively with low amplitudes in a narrow frequency range. CONCLUSIONS: Despite a subjective hearing improvement and a significant reduction of the conductive loss, otoacoustic emissions are only rarely evident after successful stapes surgery.
Quantitative evaluation of sensorineural structures following stapes surgery.
Sensorineural hearing loss may occur following stapes surgery. The reason for this remains unclear in spite of experimental studies in animals and postmortem temporal bone evaluations in humans. In this study, we quantitatively evaluated the sensorineural elements of six human temporal bones after stapes surgery. Outer hair cell loss in the upper basal turn was present in two cases. This lesion has not previously been described in human temporal bones after stapes surgery. In temporal bones with preoperative sensorineural hearing loss, evidence of presbycusis was also present. The importance of quantification in evaluating these structures must be stressed.
Preservation of the stapedius tendon in laser stapes surgery.
OBJECTIVES/HYPOTHESIS: The stapedius tendon is routinely transected during stapes surgery. The objective of this study was to evaluate the technique of stapedial tendon preservation during stapes surgery and to compare results of these cases with cases where the stapedial tendon was not preserved. STUDY DESIGN: Retrospective study. METHODS: Four groups of patients were evaluated. Two groups had undergone stapes surgery with preservation of the stapedial tendon. One of these groups underwent a laser stapedotomy minus prosthesis (laser STAMP) procedure, while the other group had a prosthesis inserted. The other two groups had undergone laser stapedotomy with one of two different prostheses being used. Audiometric data were obtained and reviewed both preoperatively and at approximately 6 weeks postoperatively. RESULTS: All groups had overall successful results demonstrating that stapedial tendon preservation is technically possible and does not compromise outcomes. CONCLUSIONS: Based on the results, it is recommended that the stapedius tendon be preserved whenever possible during laser stapes surgery. Reasons justifying its preservation are discussed.
A meta-analysis review of revision stapes surgery with argon laser: effectiveness and safety.
OBJECTIVE: To determine whether there is an advantage in safety and outcome efficacy with the use of argon laser in revision stapes surgery as compared with conventional instruments. DATA SOURCES: A search of the published English-language literature, 1970-1995, was conducted using the following key words: revision, surgery, stapes, laser, stapedotomy, and argon laser. STUDY SELECTION: The following inclusion criteria were used to select articles for the meta-analysis: revision cases only, a comprehensive review of intraoperative pathological findings that led to the failure, and accurate documentation by the author, confirmed by our statisticians using a modified chi 2 test. Eleven studies without the use of the laser (n = 1,147 patients) and four studies with the use of the laser (n = 170 patients) including our own patients (n = 23) were entered into the model. DATA EXTRACTION: The data had to meet strict audiometric criteria, including preoperative and postoperative audiogram pure tone average air-bone gap; postoperative audiograms had to include five classifications, and these audiograms had to be obtained a minimum of 6 months after revision surgery. DATA SYNTHESIS: A log-linear model was developed for this meta-analysis study, with each study analyzed individually and collectively. CONCLUSION: Revision stapes surgery using the laser demonstrated statistically significant (p = 0.002) advantage in both safety and efficacy over revision procedures using conventional instruments.
Assessment of the techniques of stapes surgery. Is there a single stapes operation preferable in every case of otosclerosis?
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[Clinical and experimental studies on stapes surgery. 2. Radiography of the stapes].
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[Stapes surgery in otosclerosis and small middle ear abnormality].
Stapes surgery in otosclerosis (first and revision operation) and in minor middle ear malformation follows the same principles, but the surgical problems are rather different. When analyzing three groups of patients, which had been operated on the same technique, we could show that the risks of the operation in malformation and revision surgery are not greater than they are in primary otosclerosis surgery. The audiologic results are more satisfying in the latter; malformation surgery and revision surgery have almost the same results which are lying somewhat below those of primary otosclerosis surgery. In the hands of an experienced surgeon, who is able to adopt his surgical technique at the individual situation, stapes surgery is nearly without risk in all these indications; an improvement of the air-conducting level of 18-23 dB can be expected and a social hearing above 35 dB can be provided in 83% of otosclerosis patients, in 79% of malformation patients and in 57% of revision patients.
Vein graft in stapes surgery.
Sealing the opening of the oval window during stapes surgery is essential; it prevents postoperative complications, such as perilymph fistula and sensorineural hearing loss. In this small series of 269 cases with otosclerosis, tympanosclerosis, and congenital ossicular abnormality, vein grafting was used to seal the opening of the footplate. Hearing improvement after surgery was acceptable, and none had total hearing loss or perilymphatic fistula. World literature from the last half of this century on grafting the oval window is reviewed. Absorbable gelatin sponge (Gelfoam) seems to be causing more complications, so its use is highly discouraged. Temporalis fascia, fat, and perivenous loose areolar tissue have been used by different authors at different times in footplate surgery. The opening created in the oval window during stapes surgery must not be left uncovered.
Results of stapes surgery - subjective and objective.
A review of subjective and objective results of stapes surgery performed by one general otolaryngologist shows excellent correlation between the two. However, hearing results are poorer, and the complication rate higher than is usually reported. We recommend that patients be informed pre-operatively of the success rate and complication rate in the practice of their surgeon rather than the excellent results reported in the literature. Patients with unilateral hearing loss should be discouraged from undergoing stapes surgery. Approximately half of these patients do not obtain binaural hearing, and thus the success rate does not justify the risk of a complication. Further studies are required to determine whether stapes surgery should be performed only by otologists doing a high volume of such surgery.
Stapes surgery in osteogenesis imperfecta: results of a new series.
OBJECTIVE: To evaluate the results of stapes surgery in osteogenesis imperfecta. STUDY DESIGN: Audiological and clinical analysis of the results of stapes surgery in a consecutive series of 15 ears in 13 patients with osteogenesis imperfecta. SETTING: Tertiary referral center. RESULTS: Stapedotomy was successful in 11 of 12 ears in 11 patients with osteogenesis imperfecta type I. Air-bone gaps were within 10 dB in four ears and within 20 dB in the seven remaining ears. In one ear, revision surgery with malleovestibulopexy was needed to achieve this result. In another ear, the initial good result within 20-dB air-bone gap decreased to 28 dB; therefore, it is not considered as a success. In one other patient, revision surgery resulted in only marginal improvement in the hearing level. In one case of, probably, osteogenesis imperfecta type III, surgery resulted in a dead ear. CONCLUSION: Stapedotomy successfully improved the hearing of patients with osteogenesis type I. These results are in accordance with those reported in a few previous series. It is questionable whether stapes surgery will be as successful in osteogenesis imperfecta types other than type I.