Stapedotomy Cases Research Articles

Outcome of hearing in stapedectomy versus stapedotomy in nonendemic areas

Background and Objectives: Stapedectomy and stapedotomy are the standard techniques for surgical treatment of stapes fixation. Both techniques differ in the size of the created opening in the stapes footplate and the type of prosthesis used. The aim of the study is to evaluate the outcomes of hearing following the two surgical techniques. Methods: One hundred and forty-nine medical records of patients who underwent stapedectomy or stapedotomy between the years 1988 and 2011 were reviewed. The subjects were classified into two groups including stapedectomy and stapedotomy. The clinical and immediate pre- and postoperative air-conduction (AC) threshold, bone conduction, and air-bone gap (ABG) were compared between the two groups. Results: The average age of patients included (n = 149) was 34.4 years at the time of surgery. The pure-tone average calculated for AC for clinical and immediate preoperative and postoperative was 57.6, 58.9, and 35.3 dB, respectively. The ABG calculated for clinical, immediate preoperative, and postoperative was 37, 36.9, and 14.5 dB, respectively. The majority of the patients (80.5%) underwent surgery for otosclerosis. Stapedectomies were done for 60.4% versus 39.6% stapedotomies. Preoperatively, the majority of patients fall within the class of moderate to moderate-severe hearing loss. Closure of ABG to 10 dB or more was achieved in 50.4% of the cases. Postoperative ABG was statistically different (P = 0.002) between the stapedectomy (16.79 dB) versus stapedotomy (10.85 dB) group. Conclusions: Stapedotomy cases were better than stapedectomy ones in closing the ABG. The frequency (250 Hz) AC threshold was better in the stapedotomy group compared to the stapedectomy one in a postoperative audiogram. No statistical difference was observed between the two groups in the other frequencies.

Review of a single surgeon’s stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period

Conclusion: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes.Objective: To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis.Methods: A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air–bone gaps (ABG) were calculated from pre-operative and post-operative audiograms.Results: Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis.

To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis. PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015. Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval. Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22). Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.

Stapedotomy and its effect on hearing - our experience with 54 cases.

This study reviews the cases of stapedotomy and evaluates its effectiveness at improving hearing loss in patients with otosclerosis. Retrospective review of patients' records who had clinical and audiometric diagnosis of otosclerosis from January to December 2012. A total of 54 stapedotomy surgeries (52 unilateral and 1 bilateral surgeries) were received. Average post-operative ABG for 0.5, 1, 2 and 4 KHz showed that 61.1% had complete closure of ABG ( ABG < 10 dB) compared with 1.6% preoperatively and 85.2% had closure of ABG to within 20dB compared with 4.7% preoperatively (t - 13.89, p = 0.000). More than 94% had hearing improvement and 81.5% had ABG closure greater than 10 dB postoperatively (mean gain 23.38 ± 12.37, t = 13.89, p = 0.000). A total of 13% complications were recorded with TM perforation (5.6%) being the commonest complication. Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patients' quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique.

CO2 laser revision stapedotomy

To evaluate the safety and efficacy of the one-shot noncontact technique in stapedotomy for revision stapes surgery with a CO₂ laser combined with a scanning system. Prospective study. Intraoperative findings and hearing results of 106 patients who underwent revision CO₂ laser stapedotomy because of conductive or sensorineural hearing loss or vertigo were analyzed. Leading pathologies were displacement of the prosthesis, incus erosion, fibrous adhesions, and bony reobliteration or a too long or too short prosthesis. Surgery was successfully performed in all cases with a noncontact technique resulting in significantly improved postoperative air and bone conduction. The rate of permanent complications was 0.9%. A comparison of the effect of higher laser energies used for the perforation of bony stapes footplates and lower energies for neomembranes revealed no significant difference in hearing results, underscoring the safety of the technique. To avoid any manipulation of the conductive hearing chain that may cause sensorineural hearing loss, we adapted the noncontact technique previously introduced by us for use in revision stapedotomy. This technique was successfully applied to improve conductive and sensorineural hearing loss as well as vertigo in first and second revision stapedotomy cases. Because the rate of postoperative complications was comparable to what is achieved with other laser systems, we conclude that the method has at least an equal level of safety. In conclusion, we advocate the use of a noncontact technique as suitable for an early revision of failed stapedotomy.

Erosion of the Long Process of the Incus in Revision Stapes Surgery

To study hearing outcome in revision stapedotomy cases where extensive erosion of the long process of the incus was observed in a consecutive series where a malleovestibular prosthesis was used versus a consecutive series where hydroxyapatite (HA) bone cement was used to rebuild the eroded long process of the incus and integrate the prosthesis. Twenty revision cases of surgically treated otosclerosis where extensive incus erosion was observed during revision surgery. In the earlier consecutive series, 10 cases were treated with malleovestibular prostheses. In the later consecutive series, 10 cases were treated with HA bone cement to rebuild the incus-prosthesis interface. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were evaluated preoperatively and at 1 to 3 months. Last audiometry available also was reported (median, 12 mo). Pure-tone averages were calculated according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. Raw data were displayed in an Amsterdam Hearing Evaluation Plot. Six male patients and 14 female patients were included. Age varied from 34 to 75 years (median, 53 yr). The median postoperative air-bone gap at last follow-up audiometry was 15.6 in the malleovestibular prosthesis group and 13.1 dB in the HA bone cement group. No short-term or intermediate-term adverse reactions or unsuspected bone conduction deteriorations were seen. HA bone cement can be successfully used to reconstruct the long process of the incus in case of extensive erosion of the long process. Intermediate-term hearing outcome is comparable to the outcome of a series of similar cases treated with malleovestibular prostheses. Because the placement of a malleovestibular prosthesis is technically more difficult and presents a high risk to the inner ear, we think HA bone cement can be a useful alternative in these difficult cases.

Bilateral hearing results of 751 unilateral stapedotomies evaluated with the Glasgow benefit plot

We aimed to evaluate bilateral hearing function in patients undergoing primary unilateral stapedotomy, according to the 1995 American Academy of Otolaryngology, Head and Neck Surgery guidelines and the Glasgow benefit plot. We also aimed to analyse the effect of pre-operative hearing impairment type on post-stapedotomy hearing. Retrospective chart review. Medical records relating to 1369 stapedotomies performed by the senior author (JJH) from 1991 to 2006 were reviewed. Seven hundred and fifty-one patients undergoing primary unilateral stapedotomy were included. Hearing results for these patients were evaluated according to the criteria of the 1995 American Academy of Otolaryngology, Head and Neck Surgery Committee on Hearing and Equilibrium guidelines, and the Glasgow benefit plot. Subgroups of patients with pre-operative unilateral, bilateral symmetrical and bilateral asymmetrical hearing loss were separately analysed. The most successful results, as regards the achievement of bilateral, socially serviceable hearing, were demonstrated in patients with unilateral hearing loss; 78 per cent of these patients had normal hearing post-operatively. Overall, patients' achievement of bilateral, socially serviceable hearing correlated highly with their type of pre-operative hearing impairment (r = 0.74). Normal post-operative hearing levels also correlated with pre-operative bone conduction (r = 0.61). This study represents the largest reported series of primary stapedotomy cases evaluated with the Glasgow benefit plot. Patients' bilateral post-operative hearing function depended on their type of pre-operative hearing impairment. Pre-operative bone conduction thresholds, corrected for Carhart's effect, were useful in predicting achievable post-operative air conduction.

Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots

To evaluate the hearing results of a large series of primary stapedotomies, according to American Academy of Otolaryngology, Head and Neck Surgery guidelines and Amsterdam hearing evaluation plots. Retrospective chart review. The charts for 1369 consecutive stapedotomy cases were reviewed; 1145 cases of primary stapedotomy were included. Raw data from the audiometric database were evaluated using Amsterdam hearing evaluation plots. The effect on outcomes of using different audiological parameters was analysed. A significant improvement was demonstrated in mean post-operative air conduction and speech reception thresholds, with no change in bone conduction. Air-bone gap closure of 10 dB or more was achieved in 82 per cent of cases. A 'dead ear' occurred in one patient (0.1 per cent). This study reports the largest series of primary stapedotomies evaluated with Amsterdam hearing evaluation plots. This method enables visual identification of successful and unfavourable results, providing more accurate and detailed presentation of surgical outcomes.

Tight Stapes Prosthesis Fixation Leads to Better Functional Results in Otosclerosis Surgery

Tight fixation of stapes prostheses yields better functional results because sound transmission from the incus to the prosthesis is improved. The optimal prosthesis to use for otosclerosis surgery is still a matter of debate. It has been proposed that using prostheses made of Nitinol, a shape-memory metal, produces better functional results with less variability and reduced risk for middle and inner ear damage. This is thought to be because heat activation rather than manual crimping of the prosthesis loop forms a tighter fixation. Functional results of two groups were compared 1 year after surgery. In one group were 75 cases of stapedotomy performed using Nitinol prostheses. Results were analyzed prospectively and compared with 75 retrospectively analyzed matched controls with conventional stapes prostheses. Crimping quality was measured in 23 patients by intraoperative laser Doppler interferometry (LDI). Causality was assessed by correlating results of intraoperative LDI and postoperative pure-tone thresholds. Nitinol and conventional prostheses yielded postoperative air-bone gaps (ABGs) of 8.0 and 11.6 dB with 71 and 43% ABG closure within 10 dB, respectively. Intraoperatively, sound transmission was improved by 2.5 dB with the Nitinol prostheses as compared with conventional prostheses. These differences were statistically significant. Intraoperative fixation quality was positively correlated to functional outcome, but results were not statistically significant. Tight fixation, as provided by Nitinol prostheses leads to improved functional results because of better sound transmission properties at the incus-prosthesis interface. The improvement in ABG closure is in the range of 3 dB pure-tone average and more pronounced at higher frequencies. Nitinol prostheses provide an effective treatment option in otosclerosis surgery.

The Learning Curve in Stapes Surgery and Its Implication to Training

To identify the stapedotomy learning curve of two U.K. otolaryngologists. A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. Two tertiary referral centers. All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of 'success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist.