Stapes Surgery For Otosclerosis Research Articles

Variation of the stapes and its surrounding anatomical structures based on micro-computed tomography.

Stapedotomy is the most efficient treatment for otosclerosis. The anatomical structure of the operation area is complex, but it has a great impact on the postoperative effect. We measure the anatomical parameters of the stapes and its surrounding structures to provide an anatomical reference for stapes surgery in otosclerosis. Fifteen adult cadaver heads (30 samples) were scanned using micro-CT. The stapes, facial nerve and external auditory canal were reconstructed by image processing. The stapes parameters and relationships between the stapes and surrounding structures were measured using a three-dimensional reconstruction model. The length, width and thickness of the stapes footplate were 2.93 ± 0.17 mm, 1.46 ± 0.08 mm and 0.30 ± 0.11 mm, respectively. The distance between the stapes footplate and long process of the incus was 3.79±0.39 mm. The angle of the incudostapedial joint was 88.29 ± 11.58°. The distance from the center of the stapes footplate to the facial canal was 1.60 ± 0.34 mm. In simulated stapes surgery, the minimum depth of the external auditory canal to be removed was 2.17 ± 0.91 mm, and no significant difference was found between the left and right sides and between men and women (P > 0.05). A three-dimensional model of the stapes bone and its surrounding anatomical structures was established based on Micro-CT imaging. Anatomical parameters of the stapes bone and its surrounding structures were measured using the model. In stapedotomy, the implanted piston diameter should be around 0.6mm, with a length of approximately 4.6mm. Care should be taken to protect the facial nerve canal during the surgery. These data provide reference for otologists.

Evolution of methods of assistance in stapes surgery in patients with otosclerosis

Introduction. It is not always possible to create a perforation in the footplate of the stirrup with the help of classical microinstruments during stapedoplasty, which will exactly correspond to the required parameters, moreover, these tools can be dangerous in some cases, since it is possible to provoke the footplate to enter the ear labyrinth, mobilizing it.Aim. To determine the efficacy and safety of various methods of stapes surgery in otosclerosis with an assessment of the frequency of intra- and postoperative complications.Materials and methods. In the Clinic of Ear, Throat and Nose Diseases of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University) a number of experimental and clinical studies were conducted, partial results of which we decided to retrospectively compare and analyze. The data of the first group of patients were taken from the results of a study with a CO2 laser. The data of the second group of patients were obtained from the results of a study with a diode (blue) laser with a wavelength of 445 nanometers. The data of the third group of patients were collected from archival data of medical histories from 2020 to 2022, who used a set of micro-tools for stapedoplasty (manual micropeforator, microneedle).Results. The data obtained showed similar results in the CO2 and blue laser groups. The main difference in the group of patients who underwent stapedoplasty with classical microinstruments was a longer operation time compared to laser stapedotomies, as well as a greater number of intraoperative difficulties associated with the mobilization of the foot plate of the stapes during manipulations with a manual perforator.Conclusions. The use of blue laser and CO2 laser in stapedotomy procedures shows promising results in terms of surgical accuracy and speed of the operation. Further research should compare the long-term effects of these three methods to determine the most effective and safest.

Stapes surgery for otosclerosis: Comparison of two techniques

Abstract BACKGROUND. Otosclerosis is a primary disease of the human otic capsule and stapes stage, being a frequent cause of conductive hearing loss in our country. The surgical treatment of choice is stapes surgery and prosthesis placement, performed in a conventional way, with a surgical microscope, for 30 years in our hospital. Recently, the option of performing stapes surgery endoscopically was introduced in our centre. OBJECTIVE. To evaluate the results in stapes surgery for otosclerosis between the conventional microscopic versus endoscopic procedure. MATERIAL AND METHODS. An observational, analytical and retrospective study on patients undergoing stapes surgery with microscopic and endoscopic technique was conducted. Data such as age, sex, state of origin, affected ear, as well as the technique used, duration of surgical intervention, hearing gain and postsurgical complications were taken. Data were taken from the records of patients admitted to the hospital. Descriptive statistics, Mann-Whitney U and Pearson’s Ji2, were used, considering a value of p≤ 0.05 as significant. RESULTS. No significant differences were found in surgical time or postoperative hearing between the two surgical techniques. The female sex was the most intervened. There was no significant difference between the post-surgical complications of both groups. CONCLUSION. Both procedures appear to be effective, with similar risks and postoperative results for the surgical treatment of otosclerosis.

Microscopic Surgical Anatomy of the Stapedius Muscle in Fresh Cadaveric Temporal Bone

Introduction: Stapedius muscle is the smallest bone in the human body and it has an important role for preventing loud noise exposing to the inner ear. This stapedius muscle has also a very significant role during stapes surgery for otosclerosis. Materials and Methods: We studied the microscopic anatomy of the 36-stapedius muscle at our temporal bone dissection laboratory during the period of March 2019 to April 2021. All the 36 fresh temporal bones were dissected with the help of the microdrill, burr, and Zeiss microscope. Details of the stapedius muscle anatomy such as origin, extension, and attachment were studied. Results: The length of the stapedius muscle was ranging from 8 to 11 mm. The tendon of the stapedius muscle was ranging from 1.5 to 2.5 mm. The classical shape of the stapedius muscle was sickle shape. The bulky bell of the stapedius muscle was from 1.5 to 3.5 mm. Discussion and Conclusion: Clear anatomical knowledge of the stapedius muscle is needed for the postgraduates and during learning period of the otologist. If anatomical knowledge is not clear, it may lead to confusion between the stapedius muscle and facial nerve. Awareness regarding microscopic anatomic is required for avoiding the confusion between the facial nerve and stapedius muscle or during the facial nerve grafting.

Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis

During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis. The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed. A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy. A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air-bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.

Is the Carhart notch a predictive factor of hearing results after stapedectomy?

SUMMARYThe Carhart notch (CN) is a depression in the bone-conduction audiogram of patients with clinical otosclerosis. The middle frequencies from 0.5 to 2 kHz, which correspond to the resonance frequency of the middle ear, can be substantially improved upon following successful stapes surgery. This retrospective audiometric database and chart review in a tertiary referral centre was performed with the aim of assessing whether the presence of a CN could be predictive of results after stapes surgery in otosclerosis, through improvement in bone conduction (BC) thresholds. Nine hundred and thirty-one cases of stapes surgery over a period of 25 years benefitted from audiological assessment before and 4 months after surgery. A CN was considered present when the BC threshold at the notch frequency (0.5, 1 or 2 kHz) exceeded the mean thresholds at higher and lower adjacent frequencies by at least 7.5 dB. BC threshold improvement was better at 2 kHz (+14.1 ± 12.5 dB vs +12 ± 13.2 dB) and lower at 4 kHz (+3.6 ± 13.5 dB vs +11 ± 14.7 dB) for the CN+ group compared to the CN- group. Moreover, sensorineural hearing loss was more frequent in the CN+ group than in the CN- group. These results indicate that a CN on preoperative audiogram should alert the clinician to lesser postoperative BC improvement at 4 kHz related to a preoperative sensorineural hearing loss or to a higher incidence of postoperative sensorineural hearing loss.

Is gelfoam sealing necessary in stapes surgery?

Background Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. Objectives To analyse the effect of using or not using Gelfoam® as a sealing material. Methods A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. Results The patients’ mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634). Conclusion and significance No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.

Teflon implants vs titanium implants in stapedotomy - A comparative study

Objective: This study compares two types of implants- a Teflon piston and a titanium piston, used in stapes surgery for otosclerosis. Study Design: A non-randomised prospective study conducted on 40 patients, in 2 groups of 20 each, undergoing stapedotomy in a tertiary care hospital. Pure tone audiometry results were noted preoperatively and 3 weeks post-operatively.Results: Both Teflon and titanium prostheses provided almost equal benefits to patients in terms of Air-Bone gap closure.Conclusion: While there is statistically no significant difference in the results observed, surgical skill of the operating surgeon plays an important role in hearing improvement and long-term results would require long term evaluation.

Predictors of hearing outcomes after stapes surgery in otosclerosis

Background: The current surgical treatment of otosclerosis is stapes surgery; however, few studies have reported the predictors of surgical outcomes.Aim/objective: This study aimed to investigate the prognostic predictors for postoperative hearing outcomes.Materials and methods: A total of 181 ears in 152 patients undergoing stapes surgery at a tertiary referral centre in Taiwan from 1996 to 2016 were retrospectively enrolled and preoperative and intraoperative parameters were obtained. Univariate and multivariate analyses were used to determine independent predictors of postoperative hearing outcomes. A regression model was also established. Hearing success was defined as a postoperative air-bone gap (ABG) ≤10 dB.Results: In univariate analysis, the absence of floating footplate during surgery (p = .003) and small preoperative ABG (p = .014) were associated with successful hearing outcomes. Multivariate logistic regression analysis further revealed the absence of floating footplate during surgery (p = .010) and small preoperative ABG (p = .015) remained independent predictors of postoperative hearing success.Conclusions and significance: Preoperative audiometric data and intraoperative finding may provide surgeons and patients with a better insight into surgical outcomes.

Significance of internal auditory canal diverticula in ears with otosclerosis

Background: Diverticula in the internal auditory canal (IAC) have been reported in ears with otosclerosis.Objective: We evaluated hearing levels and vascular activity in ears with otosclerosis with and without IAC diverticula and clarify the significance of IAC diverticula.Materials and methods: Sixty-one ears from 54 patients who underwent stapes surgery for otosclerosis [fenestral (48 ears) and retrofenestral (13 ears) groups] were included in the present study. Preoperative hearing levels on pure tone audiometry (PTA) and intraoperative measurements of blood flow were compared between the groups.Results: A total of 24 of 61 ears (39.3%) showed IAC diverticula, significantly higher than the frequency in ears without otosclerosis (3.7%). No significant differences in air- and bone-conduction thresholds on PTA were evident between ears with and without IAC diverticula in each group. Ears without IAC diverticula tended to show higher blood flow in the area anterior to the oval window than ears with IAC diverticula, but the difference was not significant.Conclusions: The incidence of the IAC diverticula in otosclerosis was significantly higher than in cases without otosclerosis. The existence of IAC diverticula was not evidently related to the severity of the disease from the perspective of hearing level and vascular activity.

Stapes Surgery for Otosclerosis in Patients Presenting with Mixed Hearing Loss

Objectives: To evaluate the efficacy of stapes surgery in patients presenting with a preoperative mixed hearing loss (bone conduction thresholds ≥40 dB; 40 < air conduction thresholds (AC) < 85 dB). Patients and Methods: A total of 30 patients (32 ears) with mixed hearing loss who underwent primary stapedotomy were evaluated. Audiometric parameters were assessed before and after surgery. Contralateral thresholds were also reported. The need for a hearing aid (HA) after surgery and its impact on quality of life were also measured. Results: AC and word recognition at 40, 55 and 70 dB were significantly improved after stapes surgery. Only 16.6% of the patients needed an HA after surgery and reported being satisfied with the aid. Conclusion: Stapes surgery improved auditory function in patients with mixed hearing loss, allowing most patients to delay the need for an HA without worsening their quality of life.

A Retrospective Study: Good Functional Outcomes are Independent of Pre-Operative Factors in Stapes Surgery for Otosclerosis

Context: Stapes surgery is the mainstay of treatment for otosclerosis. Reported success rates of stapes surgery for otosclerosis vary widely, ranging from 63.6% to 94%. The pre-operative prognostic factors of hearing outcomes after surgery are not well studied. Objective: To determine the hearing results after stapes surgery and analyze the prognostic role of pre-operative factors on hearing outcomes. Design: Retrospective study. Setting: Tertiary referral center. Patients: 90 cases of otosclerosis operated on in our institute from 2006 to 2016 were included into the study. Interventions: Stapes surgery was performed for 90 cases of otosclerosis (77 stapedotomies, 13 stapedectomies). Main outcome measures: Audiograms performed just before and six months after operation were used. We selected several pre-operative variables for analysis- age, gender, unilateral/bilateral disease, air (AC) and bone conduction (BC) thresholds, air-bone gap (ABG). Our outcomes measured were post-operative AC, ABG and percentage improvement in air-bone gap (ABGi). The associations between these pre-operative predictors and outcomes were then analyzed. Results: We report 80% (n=72) and 84.7% (n=76) of cases achieving ideal ABG (≤ 10 dB) and AC outcomes (gain in ≥ 20 dB), respectively. The mean post-operative ABG was 8.8 dB. The mean ABGi, was 78.8% with 78.9% (n=71) of cases attaining ideal ABGi (≥ 70%). Pre-operative variables did not significantly influence post-operative AC and ABG results. However, patients with larger pre-operative ABG (>30 dB) had greater ABGi (85.7 vs. 72.5%, p<0.001). Conclusion: Stapes surgery provides good and predictable results independent of disease severity or patient profile. Consequently, patients with larger hearing impairment are likely to benefit relatively more from surgery.

Predictive factors in 995 stapes surgeries for primary otosclerosis.

This study sought to identify the predictors of outcome in patients with otosclerosis undergoing primary stapes surgery. Retrospective analysis of medical records. A total of 995 patients with otosclerosis who underwent primary stapes surgery by a single surgeon between January 2006 and December 2016 were included. Logistic regression analysis was performed to examine factors affecting postoperative hearing thresholds at individual frequencies. A postoperative air-bone gap (ABG) closure ≤ 10 dB in the stapes surgery was considered as excellent outcome. Stapedotomies and stapedectomies were conducted in 823 and 172 ears, respectively. The surgeries had an overall success rate of 93.6%. Univariate analysis showed a significantly higher success rate in patients with larger prostheses (diameter = 0.6 mm). According to the results of multivariate logistic regression analysis, preoperative ABG (B coefficient = -0.10), bilaterality (odds ratio [OR] = 2.09), right ear involvement (OR = 2.00), female gender (OR = 1.81), and nonobliterative footplate (OR = 3.69) were significant prognostic factors predicting excellent outcome. Our findings indicated that the functional results were generally good. Based on logistic regression analysis, preoperative ABG and nonobliterative footplate were the most important predictors of hearing outcome after stapes surgery for otosclerosis. The success of the surgery did not depend on the procedure types (stapedotomy vs. stapedectomy) or the diameter of the prosthesis (0.4 mm vs. 0.6 mm). 4. Laryngoscope, 128:2403-2407, 2018.

A systematic review of the effect of different crimping techniques in stapes surgery for otosclerosis.

To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry. PubMed, EMBASE, and the Cochrane Library. A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss. Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB). Moderate to high risk of bias and inconsistent results characterize the current evidence. Laryngoscope, 126:1207-1217, 2016.

A systematic review of the effect of piston diameter in stapes surgery for otosclerosis on hearing results.

To evaluate the effect of piston diameter in primary stapedotomy for otosclerosis patients measured by hearing outcome. PubMed, Embase, and the Cochrane Library. A systematic search was conducted. Studies reporting original data on the effect of piston diameter on pure-tone audiometric results in patients undergoing primary stapedotomy for otosclerosis were included. Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted. Twelve studies with moderate to high relevance and moderate risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in six studies, the majority of which did not show a statistically significant or clinically relevant difference between two pistons with a different diameter. More importantly, the differences that were found were not consistently in favor of smaller-diameter pistons or larger-diameter pistons. Mean postoperative air-bone gap ranged from 3 dB in favor of a smaller-diameter piston to 3 dB in favor of a larger-diameter piston across four studies. Permanent sensorineural hearing loss was assessed in eight studies and occurred in only one study. In this study, no difference was found between a 0.4-mm-diameter piston and a 0.6-mm-diameter piston. There is not sufficient evidence to support the superiority of the use of a larger-diameter piston compared to a smaller-diameter piston for primary stapedotomy in otosclerosis patients.

Predictors of Listening Capabilities and Patient Satisfaction After Stapes Surgery in Otosclerosis

To study objective or subjective preoperative factors predicting improvement in listening capabilities and patient satisfaction after stapes surgery in otosclerosis. Prospective, multicenter study. Two tertiary referral centers. Fifty-four consecutive adult patients with otosclerosis. Stapedotomy, stapedectomy. Pure tone and speech audiometry and questionnaires were assessed preoperatively and repeated 6 months postoperatively. The questionnaires consisted of a visual analogue scale (VAS, 0-10) to score the overall quality of life, and the Operation Benefit Profile to assess the listening capability in various circumstances. Stereophony, defined by the Belfast rule of thumb, was used to divide the patients in 3 categories having unilateral, symmetric bilateral, or asymmetric bilateral hearing loss. Six patients were considered early failures of surgery, and 8 patients were lost to follow-up. In the remaining 40 patients (43 ears), all audiometric parameters improved significantly. The postoperative air-bone gap was less than 10 dB in 70%. The postoperative average air conduction threshold was less than 30 dB in 49%. The postoperative quality of life was excellent (VAS, ≥9) in 45% and did not correlate with any preoperative parameter. Preoperative and postoperative overall listening capabilities correlated slightly (Spearman r, 0.47). The postoperative VAS correlated with all postoperative audiometric parameters and the Operation Benefit Profile. Uncomplicated stapes surgery itself is the only predictor of improvement in listening capabilities and patient satisfaction 6 months after stapes surgery in otosclerosis.

Oval Window Niche Height: Quantitative Evaluation with CT before Stapes Surgery for Otosclerosis

Stapes surgery for otosclerosis can be challenging when the oval window niche is narrow. We analyzed the reliability of CT to evaluate the height of the OWN and propose a quantitative criterion to distinguish normal and narrow OWNs. Fifty-six patients were scheduled for primary stapes surgery and, with available preoperative CT scans, were prospectively enrolled in the study at a tertiary care hospital. OWN height was measured on coronal CT and qualitatively evaluated during surgery. CT findings and surgical observations were matched to determine the preoperative imaging criterion of a narrow OWN. OWN was found to be narrow during surgery in 8 of 56 patients (14%). On CT, mean OWN height measurement was 1.1 mm for the narrow group and 1.8 mm for the normal OWN surgical cases. The cutoff between normal and narrow OWN was computed at 1.3 mm by using discriminant analysis and at 1.4 mm with boxplot analysis. These CT cutoff values allowed a correct classification of "normal" and "narrow" OWN, compared with visual evaluation during surgery. Measurements of the OWN height provide an accurate and relevant evaluation of this region before otosclerosis surgery. A width below 1.4 mm should be considered at risk for technical difficulties during the stapes footplate approach.

Technical and functional hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital

The aim of this study was to assess the hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital, and to evaluate surgical trauma to the inner ear in these patients. The medical records of 387 consecutive patients who underwent unilateral stapes surgery were reviewed. Hearing results were evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines and the Glasgow benefit plot. In addition we used Amsterdam plot to give an overview on air conduction gain and bone-conduction differences on an individual level. Results were analyzed separately for patients with preoperative unilateral, bilateral asymmetrical, and bilateral symmetrical hearing loss. Despite good technical hearing results after surgery (closure of the air-bone gap to ≤20 dB in 92% of patients, air conduction gain of 24 ± 10.00 dB), only 37% of patients achieved functionally normal, symmetrical hearing. Our results indicated that the pattern of preoperative hearing impairment in patients with otosclerosis can predict postoperative functional hearing results. The type of preoperative hearing impairment had.

Day-case stapedotomy: Is it a viable option?

Conclusions: Stapedotomy is, in our opinion, the technique of choice in stapes surgery. The precision of this technique allows clinicians to perform the surgical procedure in day surgery under local anesthesia. Objectives: There is a strong emphasis on increasing the number of elective day surgery cases, especially in the patients’ best interest, as it decreases the likelihood of late cancellation and hospital-acquired morbidity. A prospective study was performed to determine whether stapes surgery for otosclerosis could be performed safely in an outpatient setting. Methods: We present a series of stapes surgery cases for otosclerosis performed on a day-case basis. We performed a classic stapedotomy in 9 patients, a reverse classic step stapedotomy in 2 patients, a partial reverse classic step stapedotomy in 11 patients, and a hemi-stapedectomy in two patients. Results: Three of 24 patients (12.5%) treated with classic stapedotomy, 1 patient with partial reverse classic step stapedotomy, and 1 patient with hemi-stapedectomy were formally admitted to the hospital after surgery (length of stay, 23 h). The indications were vertigo (two patients) and asthenia (one patient). These patients were treated under general anesthesia. Two of these patients resided more than 250 km away from the hospital.

Imaging of postoperative failures and complications in stapes surgery for otosclerosis [in French

Imaging of postoperative failures and complications in stapes surgery for otosclerosis [in French