Abstract
ObjectiveTo analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler.Study designRetrospective case review.SettingTertiary referral center.Patients and interventionsThis study concerns a retrospective analysis of the results of malleostapedotomy with the use of a self-fixing articulated titanium piston in 16 ears of 16 consecutively treated patients between 2005 and 2009. The medical files were used for the acquisition of data on medical and surgical history and to obtain pre- and postoperative audiometry. Diagnosis and outcomes of mainly revision surgeries are presented and compared to the literature.Main outcome measuresEffect of (revision) malleostapedotomy by evaluating postoperative audiometry and air–bone gap closure.ResultsThe postoperative air–bone gap closure was ≤ 10 dB in 9/16 (56%) ears and within ≤ 20 dB in 13/16 (81%) ears. The mean postoperative air–bone gap was 14.3 dB HL (0.5–2.0 kHz) and 17.3 dB HL (0.5–4.0 kHz). Postoperatively, there was no increase in bone conduction thresholds larger than 3 dB (0.5–2.0 kHz) and postoperative dizziness was absent or very limited and transient.ConclusionsThe malleostapedotomy procedure has become surgically less demanding over time by the technical improvements present in the nowadays available pistons. The design of the self-fixing and articulated titanium piston used in the present group of patients allows a safe and straight-forward malleostapedotomy procedure. Present hearing outcomes match with results presented in the literature.
Highlights
The malleovestibulopexy procedure was originally a complicated surgical procedure which even in the most experienced hands has been reported to have a relatively high percentageElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Following the gradual introduction of the incudostapedotomy procedure replacing the incudostapedectomy in the eighties of the previous century, the smaller opening of the footplate became the trend in malleostapedotomy procedures [5, 6]
This report includes 16 patients who have a clinical diagnosis of otosclerosis (n = 11), osteogenesis imperfecta (n = 1), or with a history of chronic otitis media and or tympanosclerosis (n = 4) (Table 2)
Indications for a malleostapedotomy and preoperative findings are presented in supplemental table 1
Summary
The malleovestibulopexy procedure was originally a complicated surgical procedure which even in the most experienced hands has been reported to have a relatively high percentage. The full titanium self-fixing malleus grip and articulated piston, introduced in 2004 by Häusler, renders access to the stapedotomy opening. Both the clip and the mobility at the level of the joint facilitate a more soft and gentle handling at the level of the vestibule than the. Surgical series in the literature, almost all quite limited in numbers, originated from mostly well-known otological centers (Table 1). The surgical outcomes for hearing and balance in the present series with the self-fixing articulated piston are presented below and compared to data from the literature on malleostapedotomy
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