Stapes Superstructure Research Articles

The New Semisynthetic TORP: A Prosthesis for Ossicular Reconstruction Both With the Absence and the Presence of the Stapes Superstructure.

To describe the new semisynthetic total ossicular replacement prosthesis (New-SSTORP) and to evaluate the New-SSTORP ossiculoplasty results both with the presence and absence of the stapes superstructure. Prospective study. Tertiary referral center. From April 2023 to May 2023, 18 New-SSTORP ossiculoplasties were performed by the first author. In all patients, the New-SSTORP was interposed between the footplate and the eardrum. The study group was divided into two groups (group A and group B). Group A included 13 patients with the absence of stapes superstructure. Group B included five patients with the presence of stapes superstructure. A successful reconstruction was defined as a postoperative air-bone gap ABG ≤20 dB. For all patients of groups A and B, the last audiometric control considered was performed in January 2024. The mean follow-up was 8½ months. The χ2 test was used to compare results. p < 0.05 was considered significant. Mean postoperative ABG ≤20 dB. At the end of follow-up, the overall success rate (ABG ≤20 dB) of New-SSTORP ossiculoplasty was obtained in 88.8% (n = 16 of 18) of cases. In group A, the success rate of New-SSTORP ossiculoplasty occurred in 84.6% (n = 11 of 13) of cases, and in group B, the success rate of New-SSTORP ossiculoplasty occurred in 100% (n = 5 of 5) of cases. There was no audiological statistically significant difference between groups A and B (Fisher value is 1; p < 0.05). In all cases, the time for positioning of New-SSTORP was about 5 minutes. The New-SSTORP has a minimal technical challenge for building and placement. The New-SSTORP ossiculoplasty results are very good both with the presence and absence of SS.

Analysis of the effect of reconstructing the ossicular chain under otoendoscopy with and without a stapes superstructure

Background Numerous studies have been conducted on the effect of the stapes superstructure after ossicular chain reconstruction, but the findings are not uniform. Objective To compare the hearing outcomes of ossicular chain reconstruction with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) under otoendoscopy. Materials and methods The records of 111 patients diagnosed with chronic suppurative otitis media were retrospectively analyzed. These patients were divided into PORP group (n = 57) and TORP group (n = 54). They were further subdivided into subgroups PORP-a (with a malleus handle) and PORP-b (without a malleus handle), subgroups TORP-a and TORP-b. Pre- and postoperative audiometric results were analyzed. Results The mean postoperative air conduction hearing thresholds improvement, mean air–bone gap improvement, and the success rate of reconstruction were significantly higher in the PORP group than in the TORP group (p < .05). The mean postoperative air conduction hearing thresholds improvement and the success rate of reconstruction were significantly higher in the PORP-a group than in the TORP-a group (p < .05); and similar results were concluded in comparison of the PORP-b group and the TORP-b group. Conclusions and significance The stapes superstructure has an important positive effect on the postoperative outcome of endoscopic ossicular chain reconstruction.

Morphometric study of stapes and its variation in Eastern Indian population

: For audiological prosthesis surgery morphometry of stapes is of utmost importance. Previous studies were mainly based on foreign and northern Indian population. Hence the present study.: To measure the morphometric parameters of stapes and compare the same with the previous studies.: This cross sectional observational study, performed on the ear ossicle, stapes obtained from 26 cadaveric heads. A total of (26 x 2) = 52 sets of stapes were taken out for the study. Measurements of various parameters of the ossicles were done with micrometer. Comparison among them with respect to sex, laterality and race were made. Age variation was not considered as the ossicles reach their full size at birth. Statistically significant difference in the total height of stapes was observed between male and female ossicles, but no such disparity was found between ossicles of the two sides. Height of stapes in males (mean: 3.35mm) was found to be significantly higher (p value: 0.00001) as compared to females (mean:3.18mm) in this present study. In surgeries for otosclerosis, the stapes superstructure is removed and replaced by a prosthetic ‘piston’, the selection of which is determined by the distance between the lenticular process of incus and the footplate of stapes, which in turn corresponds to the height of stapes superstructure. This measurement is vital for a properly fit piston and thus to the outcome of the surgery in terms of hearing improvement and lack of complications like expulsion of the piston, intractable vertigo, etc. When the mean values found in this study were compared with those of previous foreign and Indian studies, some of the values were found to be similar. : The height of stapes was shorter in our study as compared to studies based on North Indian population. These differences might point towards geographic or ethnic variations in the stapes which might call for further research work into this topic.

Vertigo Associated with Otosclerosis and Stapes Surgery-A Narrative Review.

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy.

Laser Stapedotomy for Otosclerosis

Otosclerosis can lead to progressive conductive hearing loss, significantly affecting the quality of life. For patients who choose surgery, the tympanic membrane is elevated and middle ear space is explored. If the surgeon confirms that the stapes is fixed in the oval window, either a stapedotomy or stapedectomy can be performed. In the stapedotomy, the surgeon removes the stapes superstructure, creates a fenestration in the footplate, and places a prosthesis from the incus through the fenestration into the vestibule. In this instance, the patient was able to regain nearly all of the hearing that had been lost as a result of stapes fixation.

Radiological and audiological predictors of stapes destruction in adherent pars tensa.

Progressive adherent pars tensa occasionally induces ossicular erosion. Specifically, stapes discontinuity adversely affects postoperative hearing. However, this irretrievable sequela is challenging to prove preoperatively, partly because perimatrix inflammation on the pars tensa can obscure the visibility of the ossicles or the partial volume effect of computed tomography (CT) imaging can hamper detailed ossicular visualization. Therefore, there is no consensus regarding the ideal timing for switching from a wait-and-see approach to a surgical one. Herein, we aimed to explore the potential predictors of stapes superstructure destruction in adherent pars tensa. This retrospective cohort study enrolled consecutive patients who underwent primary tympanoplasty for adherent pars tensa categorized as grade IV on Sadé's grading scale between April 2016 and September 2021. The impact of features on otoscopy and CT and air-bone gap (ABG) on stapes superstructure destruction was assessed using uni- and multivariable logistic regression analyses. Sixty-four ears were included. Multivariate analysis revealed the presence of debris on the adherent pars tensa (odds ratio [OR] [95% confidence interval {CI}]): 4.799 [1.063-21.668], p = 0.0415), presence of soft-tissue density occupying the oval window (OR [95% CI]: 13.876 [3.084-62.437], p = 0.0006), and a ≥ 20-dB preoperative ABG at 3kHz (OR [95% CI]: 7.595 [1.596-36.132], p = 0.0108) as independent predictors for stapes superstructure destruction. High preoperative awareness of the possibility of destruction of the stapes superstructure would enable the surgeon to make a timely decision to provide surgical intervention before progression to severe stapes destruction, thereby maintaining long-term satisfactory hearing.

Stapes Bar-Normal Stapedial Superstructure with a Mobile Footplate Fixed to the Promontory.

This report describes a case of stapedial superstructure fixation with a mobile footplate, which is a rare occurrence among the ossicular malformations that cause conductive hearing impairment. A 44-year-old man with symptoms of left-sided hearing impairment since childhood presented to our department. The eardrum was normal, and pure tone audiometry showed conductive hearing impairment with a three-frequency (500, 1000, and 2000 Hz) mean of 53.3 dB and a normal tympanogram result. An abnormal shadow was observed on the internal side of the left stapes during the three-dimensional reconstruction of computed tomography. We suspected a stapes malformation and performed an exploratory tympanotomy with transcanal endoscopic ear surgery. We found a bony bar between the superstructure of the stapes and the promontory. The mobility of the stapes was significantly improved by removing the bony bar. Findings of postoperative audiometry were normal after surgery. The treatment of such cases of stapedial fixation is simple, and the prognosis of hearing gain after surgery is quite good. Thus, regarding the treatment of patients with conductive hearing impairment, clinicians and surgeons should be aware of the possibility of single stapedial superstructure fixation.

Long-Term Anatomical and Hearing Outcomes of Canal Wall down Tympanoplasty for Tympano-Mastoid Cholesteatoma: A 20-Year Retrospective Study.

to evaluate the residual rate and the functional results after ten years from canal wall down tympanoplasty (CWD) for tympano-mastoid cholesteatoma. All the patients undergoing CWD for chronic otitis media with cholesteatoma at our ENT University Department between January 2002 and December 2022 were initially assessed. We performed clinical and diagnostic evaluation at baseline, 6 months, and then every year until an average follow-up of 10 years was obtained. Patients were consequently divided into two groups according to the presence (group A) or absence (group B) of the stapes superstructure. After the selection process, 176 ears were included. The presence of the stapes superstructure was associated with better hearing outcomes (rate of patients &lt; 30 dB) at 6 months (91.42% vs. 74.46%; p = 0.001) and 10 years (74.46% vs. 24.11%; p &lt; 0.001). Residual cholesteatoma was reported in 10 ears, which included 2/35 ears in group A (5.71 %) and 8/141 in group B (5.67 %) (p = 0.993). The recurrent cholesteatoma rate was respectively 1/35 (2.85%) vs. 3/141 (2.18%) (p = 0.516). the CWD approach to cholesteatoma allows for effective long-term anatomical disease control and good hearing results when the stapes superstructure is preserved.

A retrospective study of audiological outcomes after endoscopic tympanoplasty and tympanomastoidectomy in patients with cholesteatoma

ObjectivesTo investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. MethodsThis was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. ResultsEighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009). ConclusionsOur study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes.

Titanium Prostheses for Treating Posttraumatic Ossicular Chain Disruption.

Background:Posttraumatic chain disruption may be caused by blunt head trauma, barotrauma, or a penetrating foreign body. In cases of severe damage to the incus, or its absence, a titanium prosthesis is a good option for reconstructing the ossicular chain.Methods:A retrospective analysis was performed on 24 cases of posttraumatic ossicular chain disruption that had been treated with a titanium partial or total ossicular replacement prosthesis. Air conduction, bone conduction, and air-bone gap were measured before, 6-12 months after, and more than 2 years after the operation. Hearing thresholds were calculated as the mean of 4 frequencies (0.5, 1, 2, and 4 kHz).Results:The most common cause of ossicular chain disruption was blunt head trauma due to a traffic accident (9 of 24 cases), and there were also a diverse group of foreign bodies which caused damage. In cases where the incus was absent, or significantly damaged, titanium ossiculoplasties were performed (partial or total ossicular replacement prosthesis depending on the presence of the stapes superstructure). Analysis showed a significant improvement in average air conduction threshold and in air-bone gap after surgery (P < .05). Closure of the air-bone gap to within 20 dB was observed in 67% of patients.Conclusions:Although posttraumatic ossicular chain disruption is not common, it is suspected whenever conductive hearing loss persists for several months after injury. In such cases, ossiculoplasty with a titanium prosthesis is likely to provide satisfactory audiological results.

Hearing Results in Patients With No Ossicular Chain Reconstruction and Factors Influencing the Outcome.

Ossiculoplasty is aimed at improving or maintaining the conductive portion of hearing in patients subjected to otologic surgery. However, satisfying hearing is frequently observed after tympanoplasty even in the absence of ossicular chain reconstruction. Aims of this article would be to evaluate hearing outcomes, in terms of pure tone average air-bone gap (PTA-ABG), in patients subjected to tympanoplasty for middle ear disease whose ossicular chain has not been reconstructed, and then to investigate factors influencing those outcomes. Retrospective chart review of patients who underwent ear surgery from year 2003 to 2021 at the Otolaryngology-Head and Neck surgery department of the University Hospital of Modena was performed. Audiometric test results from patients who did not receive any ossicular chain reconstruction were collected and analyzed. Tertiary University referral center. The mean patients' follow-up was 34.1 months. Overall, mean PTA-ABG in the study population was 23.5 dB. Integrity of stapes superstructure, malleus handle and malleus head, together with the use of tragal cartilage graft over autologous temporalis fascia to reconstruct the tympanic membrane were found to be significantly associated with better hearing outcomes, as demonstrated by lower PTA-ABG values. Stapes superstructure was found to be associated with more favorable outcomes in multivariate analysis, net of confounding factors. Good hearing performance can be obtained in patients subjected to middle ear surgery, even if the ossicular chain is not reconstructed. Presence of ossicular chain remnants and the use of a rigid material for tympanic membrane reconstruction are the factors that seem to most favorably influence hearing outcomes after surgery for middle ear disease.

Inner ear impairment after stapedotomy: do the cervical vestibular evoked myogenic potentials play a diagnostic role?

Background Otosclerosis is characterized by a bony remodeling process that ends up with stapes fixation. The hearing impairment can be recovered by surgery by replacing the stapes superstructure. Due to the surgical management of the vestibule, the vestibular examination could provide an insight into the correlation between this kind of surgery and vestibular changes. Objectives To evaluate the impact of the stapedotomy on the inner ear. Methods We evaluated pure tone audiometry and the presence of vestibular evoked myogenic potentials (VEMPs) in 41 patients with otosclerosis before and after the stapedotomy operation. Results Air conduction (Ac)-VEMPs were present in 18 cases preoperatively and 31 cases postoperatively. Bone conduction (Bc)-VEMPs were present in 23 cases preoperatively and 33 cases postoperatively. ABG was closed to less than 20 dB in all cases after the operation Conclusions The preoperative Bc-VEMPS had an outstanding capability to predict the type of hearing loss. The postoperative absence of VEMPS despite the closure of ABG indicated the impact of otosclerosis on the saccular cells. The use of Thulium Laser in stapedotomy didn’t affect significantly the saccular cells. Significance Integrated use of audiometry and VEMPs was effective to evaluate the changes associated with otosclerosis and the stapedotomy operation.

Effect of disease duration on the distribution of otosclerotic foci within the stapes based on scanning electron microscopy analysis

Introduction: Otosclerosis is characterized by the presence of abnormal resorption and recalcification of the endochondral layer of the temporal bone, which is not observed in healthy subjects. The result of the alternating occurrence of both processes is the appearance of disorganized and, over time, dense, sclerotic bone tissue underlying the clinical manifestation of the otosclerotic process. Aim: The aim of the work is the chemical analysis of otosclerotic foci of the stapes superstructure with the use of a scanning electron microscope. Material and methods: Patients operated for the first time due to otosclerosis were analyzed. The removed stirrup suprastructures were examined in a Scanning Electron Microscope (SEM) using microanalytical techniques (WDXS – Wavelength-dispersive X-ray spectroscopy TEXS – Transition Element X-ray Spectrometer) and diffraction techniques (2D EBSD – Electron Backscatter Diffraction). Results: In patients with a short medical history, a statistically significant difference in calcium (Ca) concentration was found between the anterior and posterior cruses of stapes. Along with the duration of the disease, a statistically significant difference in calcium (Ca) concentration was observed between the stapes head and its cruses. In the course of the disease, degradation of the microstructure of the stapes bone tissue was observed in a scanning electron microscope. Conclusions: (A) As the otosclerotic process progresses, significant changes in the chemical composition between the individual parts of the stapes superstructure are observed; (B) The observed biochemical changes are accompanied by changes in the microstructure of bone tissue observed in SEM.

Assessing the Prognostic Value of the ChOLE Classification in Predicting the Severity of Acquired Cholesteatoma.

Objective:To assess the prognostic value of the ChOLE classification in predicting the severity of acquired cholesteatoma.Method:A retrospective chart review of patients undergoing primary cholesteatoma surgery in our tertiary referral center. The primary outcome measures were analyzed in three groups of follow up (FU): residual cholesteatoma in group A, FU > 52 weeks after last-look surgery or MRI-DWI; recurrent cholesteatoma in group B, FU > 52 weeks after last outpatient visit; and adverse events (AE) in group C, FU > 12 weeks after surgery. Cholesteatomata were staged according to the ChOLE classification. Kaplan–Meier curves were used to determine the prognostic value of the classification in predicting cholesteatoma severity, while correcting for FU.Results:No significant differences were observed between the various stages of the ChOLE classification and residual or recurrent cholesteatoma rate, nor the occurrence of AE. Cholesteatoma extension to the sinus tympani or widespread in the mastoid, as well as absence of the stapes superstructure were predictive of residual disease. Sclerotic mastoids had a lower risk of residual disease than mastoids with good or poor pneumatization and ventilation. Poorly ventilated and poorly pneumatized mastoids were associated with increased risk of recurrence. Widespread cholesteatoma in the mastoid as well as presence of preoperative extracranial complications were correlated with an increased risk of AE.Conclusion:The ChOLE classification does not predict residual nor recurrent disease, nor the occurrence of AE, in our study population. Risk factors for severe cholesteatoma were identified, potentially useful for the development of future classifications.

The aetiology of ossicular chain defects in congenital cholesteatoma.

The aim of the present study was to perform a retrospective review of the lesion sites in congenital middle-ear cholesteatoma and any accompanying ossicular defects, as well as to explore the possible aetiology of congenital middle-ear cholesteatoma associated with such ossicular chain defects. The clinical characteristics and pathogenic mechanisms of ossicular chain defects were investigated in 10 patients with early-stage congenital middle-ear cholesteatoma confirmed by surgery, from August 2011 to February 2019. Monofocal cholesteatoma was located in the anterosuperior quadrant in 3 cases and in the posterosuperior quadrant in 7 cases; all 10 cases showed an absence of the long crus of incus, and 8 cases showed a complete or partial absence of stapes superstructure. The lesions were confined to the vestibular window and the stapes region and had no contact with the long crus of the incus or stapes in nine cases. None of the 10 patients had any recurrence of cholesteatoma. Although cholesteatoma can cause erosion of ossicles, the present cases suggest that residual epithelium of the cholesteatoma may coexist with ossicular malformations. Therefore, the aetiology of the clinical characteristics in these patients may derive from residual epithelial hinderance of ossicle development.

English

BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft

The Effect of Ossicular Chain Disorders on Sound Transmission and Tinnitus Perception using Electrical Model

Human middle ear ensures sound transfer due its ossicular chain, any disorder or abnormalities in this structure leads to a conductive hearing loss (CHL). Tinnitus is a health problem, associated with hearing loss, it remains a devastating symptom. In this work, we present an electrical model of the human middle ear including middle ear cavities (ZMEC), tympanic membrane with ossicular chain (ZTOC), and stapes complex with cochlea load (ZSC). This model is modified to represent more closely the related pathologies affecting the middle ear. We will focus our analysis on ossicular chain disorder by studying the effect of increasing ossicular chain (OC) stiffness and mass in both normal middle ear structures and disconnected stapes superstructure. The change in middle ear structures and impedance allows us to simulate ossicular chain disorder effects and analyze their impact on sound transmission. This analysis allowed us to know if this disorder can eventually cause tinnitus. The results showed that the effect of ossicular chain anomalies can be studied based on frequency response of middle ear transfer function by applying only the principle of mass and stiffness, and demonstrate compared to clinical results the efficiency and simplicity of using the electrical model.

Tympanoplasty with an Intact Stapes Superstructure in Chronic Otitis Media

BACKGROUND: The objective of our study was to ascertain the functional results in terms of air bone gap (ABG) closure over 4 frequencies (0.5, 1, 2, 3 kHz) in patients with chronic otitis media (COM) that underwent tympanoplasty in the presence of a mobile stapes superstructure, and in particular excluding those cases in which the malleus was used in the reconstruction.Methods: A retrospective review of our database between January 1, 2006 and June 1, 2018 identified all cases that underwent one of 3 reconstructive options: the classic Type III tympanoplasty in an open-cavity setting; the “stapes augmentation” (SA) type reconstruction where the stapes superstructure is augmented to the drum by an interposing partial ossiculoplasty of either autologous bone, cartilage, or prosthetic material; and the use of a total articular replacement prosthesis (TORP) from the stapes footplate to the drum in the presence of an intact superstructure.Results: A total of 116 procedures in 112 patients were identified with a mean ABG reduction from 27 dB to 21 dB (P < .05). There was no significant difference in the mean post-operative ABG result between Type III (19.21 dB), TORP+ (24.90 dB), or SA (20.94 dB) reconstructions (P = .368). Overall, an ABG ≤ 20 dB or “surgical success” was achieved in 56% (n = 65) of cases. Only 20% (n = 23) of cases had “failure” or a post-operative ABG >30 dB.Conclusion: Tympanoplasty with an intact stapes superstructure in COM is expected to provide acceptable levels of surgical success. We did not identify any particular risk factors associated with improved outcome.

Stapedotomy Removing Only the Stapes Head and Not the Entire Stapes Superstructure: Long-term Results.

To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results. Prospective study. The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical. No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant. The Malafronte's stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

TORP ossiculoplasty in the presence of an intact stapes superstructure

IntroductionIn this series, we describe ossicular reconstruction using routine TORP in the presence of the stapes superstructure using a tympanic-membrane-to-footplate configuration. Materials and methodsThis is a case series of 12 patients who underwent TORP ossiculoplasties from 1st January 2010 to 31st October 2017. Data collected included demographics, indication for surgery, status of the middle ear and pre-operative and post-operative audiometric data (including pure tone average (PTA) and air-bone gap (ABG)). ResultsThe mean pre-operative PTA was 56.5 dB and ABG was 39.8 dB. Surgical success (ABG ≤ 20 dB) was achieved in 83.3%, with an average improvement in PTA of 24.3 dB and closure of ABG of 27.1 dB. The mean post-operative ABG was 12.7 dB. ConclusionTORP ossiculoplasty with tympanic-membrane-to-footplate configuration is a feasible means of ossicular reconstruction, independent of the status or spatial arrangement of the remnant ossicles. Using this technique, it is possible to achieve a consistently good outcome for improvement in hearing and closure of ABG.