Small Fenestra Research Articles

Clinical outcomes and bone resection analysis of unilateral double-channel endoscopic technique in treating lumbar disc herniation

To explore clinical outcomes and bone resection of interlaminar fenestration decompression and unilateral biportal endoscopic (UBE) technique in treating lumbar disc herniation(LDH). A retrospective study was performed on 105 patients with single-level LDH treated from December 2019 to December 2021. Fifty-four patients in UBE group,including 32 males and 22 females,aged from 18 to 50 years old with an average of(38.7±9.3) years old,were treated with UBE,29 patients with L4,5 and 25 patients with L5S1. There were 51 patients in small fenestration group,including 27 males and 24 females,aged from 18 to 50 years old with an average of (39.9±10.0) years old,were treated with small fenestration,25 patients with L4,5 and 26 patients with L5S1. Perioperative indexes,such as operation time,postoperative time of getting out of bed and hospital stay were observed and compared between two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between two groups before operation and 1,3,6 and 12 months after operation,respectively;and modified MacNab evaluation criteria was used to evaluate clinical efficacy. Amount of bone resection and retention rate of inferior articular process laminoid complex were compared between two groups. All 105 patients were successfully completed operation. Both of two groups were followed up from 6 to 12 months with an average of (10.69±2.49) months. Operation time,postoperative time of getting out of bed and hospital stay were (58.20±5.54) min,(2.40±0.57) d and (3.80±0.61) d in UBE group,and (62.90±7.14) min,(4.40±0.64) d and (4.40±0.64) d in small fenestrum group,respectively;and had statistically difference between two groups(P<0.05). Postoperative VAS of low back and leg pain and ODI in both groups were significantly lower than those before surgery (P<0.05). VAS of lumbar pain in UBE group (1.37±0.49) score was lower than that of small fenestration group (2.45±0.64) score,and had statistically difference (t=9.745,P<0.05). Postoperative ODI in UBE group at 1 and 3 months were (28.54±3.31) % and (22.87±3.23) %,respectively,which were lower than those in small fenestra group (36.31±9.08) % and (29.90±8.36) %,and the difference was statistically significant (P<0.05). There were no significant difference in VAS and ODI between two groups at other time points (P>0.05). According to the modified MacNab evaluation criteria at the latest follow-up,49 patients got excellent result,3 good,and 2 fair in UBE group. In small fenestration group,35 patients got excellent,12 good,and 4 fair. In UBE group,amount of bone resection on L4,5 segment was (0.45±0.08) cm3 and (0.31±0.08) cm3 on the segment of L5S1. In small fenestration group,amount of bone resection on L4,5 segment was (0.57±0.07) cm3 and (0.49±0.04) cm3 on the segment of L5S1,and amount of bone resection of lower articular process laminar complex on the same segment in UBE group was less than that in small fenestration group (P<0.05). In UBE group,retention rate of laminoid complex on L4,5 segment was (0.73±0.04) and L5S1 segment was (0.83±0.03),while L4,5 segment was(0.68±0.06) and L5S1 segment was (0.74±0.04) in small fenestration group,the lower articular process laminar complex retention rate in UBE group was higher than that in small fenestration group(P<0.05). Both unilateral double-channel endoscopy and small fenestration of laminae could achieve good clinical results in treating LDH,but UBE has advantages of less trauma,higher efficiency,faster postoperative recovery and less damage to bone structure.

Small Fenestra Stapedotomy in Comparison to Large Fenestra Stapedectomy in Improving Hearing Loss Caused by Otosclerosis: A Retrospective Study

Background: A retrospective study done on all otosclerotic patients who underwent stapes surgery between January 2019 and June 2022 in the department of otorhinolaryngology in a tertiary care hospital in North India. Material and Methods: Fifty four patients were enrolled in the study. The inclusion criteria of the study included patients in the age group of 18–55 years with conductive hearing loss and an intact tympanic membrane and an air–bone gap (ABG) of more than 30 dB. Diagnosis of otosclerosis is based on clinical history of progressive hearing loss and audiometric evaluation. Pure Tone Average shows typical conductive hearing loss pattern. Aim and Objective: Preoperative and 6 months postoperative audiological evaluation was conducted to understand the difference in hearing. The same surgical technique was used in all the cases, except that the dimension of the foot plate removed was different. Results: The mean age of patients in years who underwent stapes surgery was 31.6 ± 6.4 years. Out of the 54 patients, 24 (44.44%) were male and 30 (55.56%) were female. The number of patients who underwent large fenestra stapedectomy was 30 (55.56%) and who underwent small fenestra stapedotomy was 24 (44.44%). There was a significant improvement in the hearing parameters (PTA and ABG) in both the groups after surgery, but there was no significant difference between the small fenestra and large fenestra groups in terms of improvement in PTA and ABG. Conclusion: In conclusion, both small fenestra stapedotomy and large fenestra stapedectomy are safe and effective procedures for improving conductive hearing loss in otosclerosis patients.

How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome

BackgroundIn clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis.MethodsA stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital’s Department of Neurosurgery between January 2017 and January 2022.ResultsAll patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported.ConclusionsThe use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.

A retrospective study on the outcomes of stapedotomy with vein graft interposition and vein graft surround techniques.

This study evaluated audiological outcomes of stapedotomy using two different techniques, vein graft interposition and vein graft surround, for sealing the stapes fenestra. A retrospective study of 130 patients who underwent stapedotomy for otosclerosis was performed. A total of 84 patients underwent the vein graft surround procedure and 46 underwent the vein graft interposition procedure. Post-operative hearing outcome was compared between them. A total of 55 of 130 patients had a post-operative air-bone gap of less than 10 dB. A total of 57 patients had an air-bone gap within 20 dB. The average air-bone gap was 13.16 dB at 3 months with a mean improvement of 22.06 dB (11.98 dB for vein graft interposition and 13.80 dB for vein graft surround; p = 0.79). There was no significant difference in hearing outcome between the two techniques. The vein graft interposition technique is preferred for large fenestra or stapedectomy cases and in cerebrospinal fluid gusher cases. The vein graft surround technique is easier to perform and preferred in small fenestra stapedotomy.

Choice of vector and surgical approach enables efficient cochlear gene transfer in nonhuman primate

Inner ear gene therapy using adeno-associated viral vectors (AAV) promises to alleviate hearing and balance disorders. We previously established the benefits of Anc80L65 in targeting inner and outer hair cells in newborn mice. To accelerate translation to humans, we now report the feasibility and efficiency of the surgical approach and vector delivery in a nonhuman primate model. Five rhesus macaques were injected with AAV1 or Anc80L65 expressing eGFP using a transmastoid posterior tympanotomy approach to access the round window membrane after making a small fenestra in the oval window. The procedure was well tolerated. All but one animal showed cochlear eGFP expression 7–14 days following injection. Anc80L65 in 2 animals transduced up to 90% of apical inner hair cells; AAV1 was markedly less efficient at equal dose. Transduction for both vectors declined from apex to base. These data motivate future translational studies to evaluate gene therapy for human hearing disorders.

Primary stapedotomy: Influence of prosthesis diameter on hearing outcome

ObjectivesTo evaluate the success rate of primary stapedotomy and to investigate the influence of prosthesis diameter on hearing outcome. Material and methodsRetrospective medical chart review of 125 cases who underwent primary small fenestra stapedotomy, from January 2001 to December 2018. The study population was divided in two groups based on Teflon prosthesis diameter – .6mm (60%, N=75) and .4mm (40%, N=50). Pre- and postoperative (≥12 months) air-conduction (AC), bone conduction (BC) and air-bone gap (ABG) thresholds were compared. ResultsPostoperative ABG≤10dB and ≤20dB was achieved by 65.7% and 90% of the patients. A functional hearing (PTA-AC≤30dB) was achieved by 59.2% of patients. Sensorineural hearing loss (SNHL, worsening in BC-PTA>10dB) was identified in 7.2% of patients. Comparison of the .6mm- and .4mm-groups, revealed no differences regarding improvements in AC-PTA (22.4 vs. 20.7dB, p=.56), BC-PTA (3.4 vs. 2.3dB, p=.54) and ABG-PTA (19.1 vs. 18.4dB, p=.77). Hearing outcome evaluation identified similar postoperative success rate (.6mm, 79.7% vs. .4mm, 62%, p=.336) and comparable functional hearing (.6mm, 64% vs. .4mm, 52%; p=.197). The incidence of postoperative SNHL was similar between the two pistons (.6m, 5.3% vs. .4mm, 10%, p=.481). ConclusionPrimary small fenestra stapedotomy is an effective and safe procedure. A postoperative ABG within 10dB was achieved in 67.2% of patients and there was a reduced incidence of sensorineural hearing loss. Hearing outcome was not influenced by diameter of the selected prosthesis. Postoperative bone conduction hearing thresholds did not differ between the groups, which revealed no significant inner ear trauma caused by the larger piston. Although we did not find evidence to suggest one piston over the other, our results showed a trend toward better results with the larger prosthesis.

Fifteen-Year Follow-Up of Stapedotomy Patients: Audiological Outcomes and Associated Factors in a Middle Income Country

Objective: To evaluate the short-term (postoperative), medium-term (5 years), and long-term (10 and 15 years) audiometric results of patients who underwent stapedotomy and to determine specific factors associated with better postoperative outcomes. Methods: This study is a retrospective case review of 486 ears with surgically confirmed stapes fixation who underwent microscopic small fenestra stapedotomy. Preoperative, postoperative, and medium- and long-term air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were assessed. Postoperative factors associated with better postoperative outcomes were evaluated. Results: At 10- and 15-year follow-ups, ABG, AC, and BC were significantly deteriorated but clinically preserved in comparison with postoperative results. According to a multiple quantile regression, younger age was associated with better postoperative results at 0.25 kHz (p = 0.003) and 4 kHz (p = 0.028) and a smaller preoperative ABG was associated with better audiometric results at 0.25 kHz (p = 0.048), 0.5 kHz (p = 0.001), and 4 kHz (p = 0.001). In addition, younger age (p = 0.001 for AC and p < 0.001 for BC) and preoperative AC PTA (p < 0.001 for AC) were significantly associated with better postoperative AC and BC PTA. Conclusions: Stapedotomy surgery provides short-, medium-, and long-term hearing benefits in our studied cohort. ABG, AC, and BC thresholds obtained after the surgery are clinically preserved in 5-, 10-, and 15-year follow-ups, with an age-expected BC deterioration. Smaller preoperative ABG and younger age were positive predictors for better postoperative ABG. Future research should address long-term subjective and quality of life outcomes.

Primary stapedotomy: Influence of prosthesis diameter on hearing outcome

ObjectivesTo evaluate the success rate of primary stapedotomy and to investigate the influence of prosthesis diameter on hearing outcome. Material and methodsRetrospective medical chart review of 125 cases who underwent primary small fenestra stapedotomy, from January 2001 to December 2018. The study population was divided in two groups based on Teflon prosthesis diameter – .6mm (60%, N=75) and .4mm (40%, N=50). Pre- and postoperative (≥12 months) air-conduction (AC), bone conduction (BC) and air-bone gap (ABG) thresholds were compared. ResultsPostoperative ABG≤10dB and ≤20dB was achieved by 65.7% and 90% of the patients. A functional hearing (PTA-AC≤30dB) was achieved by 59.2% of patients. Sensorineural hearing loss (SNHL, worsening in BC-PTA>10dB) was identified in 7.2% of patients. Comparison of the .6mm- and .4mm-groups, revealed no differences regarding improvements in AC-PTA (22.4 vs. 20.7dB, p=.56), BC-PTA (3.4 vs. 2.3dB, p=.54) and ABG-PTA (19.1 vs. 18.4dB, p=.77). Hearing outcome evaluation identified similar postoperative success rate (.6mm, 79.7% vs. .4mm, 62%, p=.336) and comparable functional hearing (.6mm, 64% vs. .4mm, 52%; p=.197). The incidence of postoperative SNHL was similar between the two pistons (.6m, 5.3% vs. .4mm, 10%, p=.481). ConclusionPrimary small fenestra stapedotomy is an effective and safe procedure. A postoperative ABG within 10dB was achieved in 67.2% of patients and there was a reduced incidence of sensorineural hearing loss. Hearing outcome was not influenced by diameter of the selected prosthesis. Postoperative bone conduction hearing thresholds did not differ between the groups, which revealed no significant inner ear trauma caused by the larger piston. Although we did not find evidence to suggest one piston over the other, our results showed a trend toward better results with the larger prosthesis.

Stapedotomy post-operative results and complications

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Otosclerosis is a hereditary localized disease of the bone derived from the otic capsule. It is characterized by alternating phases of bone formation and resorption and patient presents with conductive hearing loss. Treatment of otosclerosis can be of two kinds: hearing aids and surgery. Stapedectomy and stapedotomy are the two surgical procedures done for treatment of otosclerosis. Present study was conducted on 30 patients with otosclerosis who underwent stapedotomy to assess the hearing results post-surgery by serial Audiometric studies and to study the complications of stapedotomy surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective observational study conducted on 30 patients of otosclerosis who fulfilled the inclusion and exclusion criteria. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study of thirty cases of otosclerosis which were operated for small fenestra stapedotomy, we conclude that Hearing gain post-surgery was remarkable especially for patients with a pure conductive hearing loss. There was no deterioration in hearing after two years of follow-up. In our study on 30 patients we encountered minor complication in 4 patients (13.33%) and 1 major complication of profound sensorineural hearing loss 3.33%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that stapedotomy is a relatively safe procedure with significant post-surgery hearing benefit.&lt;/p&gt;

Comparative study showing relevance of prosthesis diameter and hearing outcome in stapes surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Otosclerosis presents as conductive hearing loss, stapedotomy is the treatment for otosclerosis, and different sizes of piston diameter are available for the procedure. Aims and objectives were to study and compare hearing improvement between the 0.4 and 0.6 mm sizes of teflon piston in stapedotomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a prospective randomized controlled trial. Patients fulfilling inclusion criteria were subjected for small fenestra stapedotomy. Patients were divided into two groups after randomization into group A (with 0.4 mm piston diameter) and group B (with 0.6 mm piston diameter). The hearing outcome with standard audiological assessment was performed at one month and six months postoperatively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Comparison of 1 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.699). Comparison of 6 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.54).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There was no significant difference in hearing improvement among the individual methods (piston size 0.4 and 0.6) with each other both in 1 month post-operative and 6 month post-operative follow up. Hence, we conclude that there is no relevance of different diameter of teflon piston prosthesis (0.4 mm versus 0.6 mm) as far as hearing outcome is concerned.&lt;/p&gt;

Short-term audiological outcomes of stapedotomy: microdrill at low revolutions versus manual perforator to perform a small footplate fenestra. A prospective observational study.

&lt;b&gt;Introduction:&lt;/b&gt; Stapedotomy is currently the surgical technique of choice for treating otosclerosis. Despite this, there is no agreement about the best technique to perform a small fenestra footplate, therefore multiple procedures have been proposed. The aim of this study was to investigate the hearing outcomes of microdrill and manual perforator. &lt;br&gt;&lt;b&gt;Material and Methods:&lt;/b&gt; An observational prospective study was carried out on patients who underwent stapedotomy. We analyzed the hearing threshold in two groups of patients according to the way the fenestra footplate was realized by microdrill or manual perforator. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; A total of 113 patients were evaluated. Postoperative hearing gain of the microdrill group was 23.29 (18.58) dB HL 95% CI (18.40-28.18), while in the manual perforator group, it was 22.67 (12.91) dB HL 95% CI (19.07-26.26). Both groups were statistically significant. Postoperative bone conductive hearing threshold at the frequencies of 0.5, 1 and 2 KHz and postoperative air conductive hearing threshold at the frequencies of 2 and 4 KHz showed statistically significant differences in the manual perforator group. The closure of air-bone gap was higher in the microdrill group with statistically significant differences. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Both manual perforator and microdrill have good hearing outcomes at six months after surgery. The manual perforator has better audiological outcomes than microdrill. Hence, the manual perforator is a safe technique and can be used in centers that do not have other methods to make the small fenestra.

Small Fenestra Stapedotomy Versus Large Fenestra Stapedectomy in Improving Hearing Ability in Patients with Otosclerosis: Our 10Years Experience.

The aim of this study was to review the experience with surgical treatment of otosclerosis over the last 10years at Amrita Institute of Medical Sciences and Research Centre and to compare it with reported outcomes. A total of 125 patients who had reported between January 2008 and June 2018 were selected for the study. The inclusion criteria for the study included the age group 15-60years, conductive hearing loss with intact tympanic membrane and an air-bone-gap (ABG) of more than 30dB. The exclusion criteria included patients below 15years of age and above 60years of age, patients with chronic otitis media and the cases of revision stapes surgery. Audiological evaluation was conducted prior to the surgery and post operative audiological evaluation was also performed after 1month to understand the difference in hearing. In all cases the same surgical technique was used, only the dimension of the foot plate removed varied. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) (version windows base system, SPSS Inc. Chicago IL USA) software. Mean age in years who underwent surgery is 37.8 ± 11.4 and duration of disease in months median 36months (range 1-120months). Of the 125 patients (42% males and 58% females), 73 patients underwent large fenestra stapedotomy, and 52 patients underwent small fenestra stapedotomy. There was significant improvement in the following hearing parameters studied (puretone average of air conduction thresholds-PTA, ABG) in both the groups after surgery. There was no significant difference between the small fenestra and large fenestra groups with respect to improvement in PTA and ABG. On comparison of SDS (pre and post surgery) statistically significant difference was noted only in small fenestra group. However, this difference of SDS was not significant in between group comparison (stapedotomy versus stapedectomy). In summary both techniques are safe and effective treatment for conductive hearing loss in otosclerosis patients. There appears to be no deleterious effects of either procedures on hearing function. Similar results can be obtained in experienced hands using either technique. The absence of serious complications makes it reasonable to perform stapes surgery in both ears in patients with bilateral otosclerosis with conductive hearing loss.

Otosclerosis Revisited

Introduction: Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. Stapedectomy /stapedotomy is the current treatment of choice for conductive component of Otosclerosis.&#x0D; Materials and Methods: Sixty patients attending the department of ENT of a Medical College Hospital in Bangalore between October 2012 and October 2017 were included in the study.&#x0D; Results: The incidence of otosclerosis is highest in the 3rd and 4th decade. Bilateral symptoms were present in 25% and 75% had unilateral symptoms, right side being more common in our study. Tinnitus and vertigo with deafness are seen in 60% and 25 % of the patients respectively.&#x0D; Ninety percent of the patients presented with moderate to moderately severe hearing loss. Twenty four (40%) out of 60 audiograms studied showed Carhart's notch. Postoperativeclosure of a-b gap to within 10dB could be achieved in 65% cases. The p value calculated comparing pre and post op results is &lt;0.0001 and significant.&#x0D; Vertigo was found to be most common post-operative complication (35%) followed by sensorineural hearing loss (6.6%). Other complications observed during the study include - tympanic membrane tears, foot plate extrusion, lax long process of incus, perilymph leak.&#x0D; Conclusion: From the assessment of the postoperative hearing gain and postoperative complications, it can be concluded that small fenestra stapedotomy gives satisfactory post-operative outcome and may be appropriatein the Indian scenario.

Improvement of hearing results by bone cement fixation in endoscopic stapedotomy

This study aimed to compare the hearing results of two different stapedotomy techniques used in the clinic at different time points. An endoscopic surgery group (group 1; n = 37) were compared retrospectively with a microscopic surgery group (group 2; n = 57). A small fenestra and Teflon piston technique were used in all patients. Bone cement was used for fixation between the prosthesis and incus in the endoscopic group only. Bone conduction threshold and air-bone gap were used as the comparison parameters. The pre-operative air-bone gap was 31.26 dB in group 1 and 32.51 dB in group 2. The post-operative air-bone gap was 8.93 dB in group 1 and 14.28 dB in group 2. There was a significant difference between the groups in post-operative air-bone gaps. There was no significant difference between the groups in post-operative bone conduction thresholds. The endoscopic technique using bone cement fixation was better for closing the air-bone gap.

Post Stapedotomy Vestibular Deficit: Is CO2 Laser Better than Conventional Technique? A Non-randomized Controlled Trial.

The current standard of care for surgical management of Otosclerosis is small fenestra stapedotomy, which can be done by CO2 Laser assisted as well as conventional techniques. Vertigo is the commonest complication after stapes surgery. The use of CO2 Laser has been rising recently owing to its no touch principle, high precision and possibly lower risk of vertigo post operatively. To compare the post-operative vestibular deficit in patients of Otosclerosis having undergone small fenestra stapedotomy by conventional versus CO2 Laser assisted technique. 80 clinically diagnosed Otosclerosis patients fulfilling the inclusion criteria were enrolled. They underwent small fenestra stapedotomy by either conventional or CO2 Laser assisted technique. Vestibular function was assessed objectively by measuring sway velocity using modified clinical test of sensory interaction on balance by static posturography. Subjective measurement of balance was done using Vestibular balance subscore of Vertigo Symptom Score (VSS-sf-V). The outcome measures were compared pre-operatively and at first and fourth week post-operatively. All patients had vestibular deficit 1week post-operatively in the form of increased sway velocity and symptom scores, which reduced by 4weeks after Stapedotomy. The vestibular deficit in the two groups was similar at 1week after surgery. 4weeks after surgery, the sway velocity in conventional group was significantly greater than Laser group though there was no significant difference in the symptom scores. The use of CO2 Laser for Stapedotomy results in lesser post-operative vestibular deficit as compared to conventional method.

A Prospective Study of Efficacy of Small Fenestra Stapedotomy at a South Asian Center

Abstract Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy. Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data. Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation. Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.

Hearing Outcome With the Use of Glass Ionomer Cement as an Alternative to Crimping in Stapedotomy.

To evaluate early hearing outcomes using glass ionomer cement to fix the Teflon piston prosthesis onto the long process of incus to minimize residual conductive hearing loss after stapedotomy. Original report of prospective randomized control study. Tertiary referral center. A total of 80 consecutive patients with otosclerosis were randomized into two groups. Group A is a control group in which 40 patients underwent small fenestra stapedotomy using the classic technique. Group B included 40 patients who were subjected to small fenestra stapedotomy with fixation of the incus-prosthesis junction with glass ionomer bone cement. Stapedotomy with the classical technique in group A and the alternative technique in group B. The audiometric results before and after surgery. Analysis of the results was performed using the paired t test to compare between pre and postoperative results. χ test was used to compare the results of the two groups. A p value less than 0.05 was considered significant from the statistical standpoint. Significant postoperative improvement of both pure-tone air conduction thresholds and air-bone gaps were reported in the two studied groups. The postoperative average residual air-bone gap and hearing gain were statistically significant in group B (p < 0.05) compared with group A. The use of glass ionomer bone cement in primary otosclerosis surgery using the aforementioned prosthesis and the surgical technique is of significant value in producing maximal closure of the air-bone gap and better audiological outcomes.

Hearing and Otoacoustic Emissions Outcome of Stapedotomy: Does the Prosthesis Diameter Matter?

To compare the hearing and otoacoustic emissions (OAE) outcome of stapedotomy employing 0.4 and 0.6 mm diameter prostheses. In total, 18 patients with otosclerosis participated in a prospective, double-armed, randomized cohort study. All the patients underwent small fenestra drill stapedotomy employing the Causse fluroplastic large loop piston prostheses. The patients were randomly assigned to groups of 0.4 mm (n=9) and 0.6 mm (n=9) diameter prostheses. The results of pure tone air and bone audiometries, speech audiometry, and OAE conducted 12 months post operatively were compared within and between the groups. The within-group analysis showed significant post-stapedotomy improvements in the average air conduction pure tone thresholds in both groups (52.9±9.6 vs. 25.6±5.2 dB HL; p<0.0001 and 54.6±10.4 vs. 22.2±8.2 dB HL; p<0.0001 for the 0.4 and 0.6 mm groups, respectively) and average air-bone gap (ABG; 37.1±8.5 vs. 8.1±3.9 dB HL; p<0.0001 and 38.3±7.5 vs. 9.9±4.5 dB HL; p<0.0001 in the 0.4 and 0.6 mm groups, respectively). No significant differences were found between the groups in these outcome measures, as well as in the rate of ABG closure within 10 dB HL and the word recognition scores. Favorable outcome in the post-stapedotomy bone conduction (BC) was found for the 0.6 mm prosthesis group, reflecting superior cancellation of the Carhart phenomenon for the 500-3000 Hz pure tone thresholds average (-1.7±3.7 vs. 3.9±6.2 dB HL for the 0.4 and 0.6 mm groups, respectively; p<0.04) and 1000, 2000, and 4000 Hz average (-2.6±4.33 vs. 3.9±7.8 dB HL for the 0.4 and 0.6 mm groups, respectively; p<0.05). Small signal-to-noise ratio (SNR) values of the transient-evoked OAE (TEOAE) and distortion product OAE (DPOAE) were found at baseline and follow-up evaluation with no consistent changes post stapedotomy. Similar post-stapedotomy hearing results were found for the 0.4 and 0.6 mm prostheses with small but statistically significant advantage in BC gain and the overclosure parameter for the 0.6 mm prosthesis. OAE testing was not found to be of clinical value in the evaluation of stapedotomy hearing outcome.

Endoscopic exploratory tympanotomy findings in conductive hearing loss: a surgical review

Background: Conductive hearing loss continue to remain undiagnosed in a large number of patients with intact membrane. Endoscope assisted tympanotomy provides an alternative technique for diagnosis and also facilitates treatment. Methods: A prospective analysis over a 5 year period of 72 exploratory tympanotomies for conductive hearing loss was performed in patients with intact tympanic membrane. Per operative findings were treated in the same sitting. Post-operative follow up of the patient was done up to 6 months. Results: The most common operative diagnosis was found to be otosclerosis (66%), followed by traumatic ossicular dislocation, tympanosclerotic patch, middle ear adhesions, foreign bodies etc. Small fenestra Stapedotomy with prosthesis insertion was the preferred surgical procedure performed in this study, resulting in perceptible hearing improvement post operatively. Conclusion: Endoscope assisted tympanotomy and associated middle ear surgeries serves as an effective diagnostic and therapeutic option. This study is of value in assessing the surgical challenges in diagnosis and definitive treatment for conductive hearing loss with an intact tympanic membrane.

Pre and Post-Operative Evaluation of Small Fenestra Stapedotomy in StapedialOtosclerosis

Pre and Post-Operative Evaluation of Small Fenestra Stapedotomy in StapedialOtosclerosis