Abstract
IntroductionUltrasonic bone removal devices (UBD) are capable of cutting through bony tissue without injury to adjacent soft tissue. The feasibility and safety of using this technology for removal of bone from an intact ossicular chain (as might be required for otosclerosis or congenital fixation) was investigated in an animal model.MethodsThis was a prospective animal study conducted on seven anesthetised adult chinchillas. An UBD was used to remove bone from the malleus head in situ. Pre and post-operative distortion product otoacoustic emission (DPOAE) levels and auditory brainstem response (ABR) thresholds were recorded. Scanning electron microscopy (SEM) was used to assess cochlear haircell integrity.ResultsPrecise removal of a small quantity of bone from the malleus head was achieved by a 30s application of UBD without disruption of the ossicular chain or tympanic membrane. DPOAEs became undetectable after the intervention with signal-to-noise ratios (SNR) < 5 dB SPL in all ears. Furthermore, ABR thresholds were elevated > 85 dB SPL in 13 ears. SEM showed significant disruption of structural integrity of the organ of Corti, specifically loss and damage of outer haircells.ConclusionsAlthough UBD can be used to reshape an ossicle without middle ear injury, prolonged contact with the ossicular chain can cause structural and functional injury to the cochlea. Extensive cochlea pathology was found, but we did not investigate for recovery from any temporary threshold shift. In the authors’ opinion, further study should be undertaken before consideration is given to use of the device for release of ossicular fixation.Graphical abstract
Highlights
Ultrasonic bone removal devices (UBD) are capable of cutting through bony tissue without injury to adjacent soft tissue
Seven chinchillas underwent successful middle ear surgery with removal of bone from the malleus and complete postoperative distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) recording
DPOAE signal-to-noise ratios (SNR) of < 5 dB SPL at 1, 2, 4, and 8 kHz, consistent with profound hearing loss occurred in all 14 ears after UBD intervention
Summary
Ultrasonic bone removal devices (UBD) are capable of cutting through bony tissue without injury to adjacent soft tissue. Siu et al Journal of Otolaryngology - Head and Neck Surgery (2021) 50:23 reported when using the device for stapedotomy and other middle ear surgeries [5, 6], while other studies describe high-frequency hearing loss and postoperative vertigo from similar procedures using the same device [10, 11]. These studies in various human and animal settings have all concluded that more research is required for a more comprehensive understanding of its safety in otologic surgery [5, 6, 10,11,12]. An animal model was used to evaluate the effects of UBD application to an intact ossicular chain, such as might be performed for release of congenital ossicular fixation or otosclerosis
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