Stapes Research Articles (Page 1)

Effect of conservation method on ear mechanics for the same specimen

English

Embryology of stapes has long been a topic of controversy. There are theories stating a single source to the dual origin of stapes. Chronic otitis media is also known to cause various acquired bony ossicular fixations. We present a case of an 11-year-old female with right chronic otitis media, active squamosal with cerebellar abscess who underwent drainage of cerebellar abscess followed by tympanomastoidectomy as a two-staged procedure. Intraoperatively, there were stapes suprastructure fusion to the fallopian canal and one crural attachment to the promontory. There are no clear criteria to differentiate bony fixation of congenital origin from acquired causes. This case also highlights the need to add a new subclass in the classification of minor middle ear anomalies given by Cremer, and our findings also support the dual origin for stapes development.

Introduction: Although operating microscope is used worldwide for stapes surgery, the use of endoscopes would provide much benefit such as good panoramic view of middle ear and easy accessibility of the oval window area, stapes, and facial nerve. Objective: We aimed to analyze our experiences of endoscopic transcanal stapedotomy performed at a tertiary care teaching hospital of Eastern India. Materials and Methods: This prospective study was done at the Department of Otorhinolaryngology between March 2017 and April 2019. The patients were diagnosed as having otosclerosis with fulfilling the selection criteria. All underwent endoscopic transcanal stapedotomy. Results: Out of 52 patients those underwent endoscopic transcanal stapedotomy, there were 28 females and 24 males. The mean age was 32.40 years. The mean operation time was 35.43 min. The mean preoperative air–bone gap (ABG) was 34.84 dB, whereas the mean postoperative ABG was 9.81 dB. Tympanomeatal flap tear was seen in one case. One case showed chorda tympani injury and two patients presented with vertigo after surgery. No other complications were seen after endoscopic stapedotomy. Conclusion: The important advantages of endoscopic stapedotomy are good-quality visualization with identification of vital parts of the middle ear cleft, minimal handling to the chorda tympani nerve with almost no curettage of the scutum. The development of endoscopic ear surgery techniques promises the change the way we approach for stapes surgery. The wide field view of endoscope helps the surgeon to visualize better the middle ear recess, especially oval window niche and stapes.

Objective:Retrospctive analysed the Characteristics and outcomes of surgical treatment of 18 patients who were diagnosed as secondary acquired cholesteatoma (SAC).Method:Patients with SAC accepted operations were enrolled in this study. Then the factors such as sex, age, cource of history, otorrhea before operation, the size of perforation of tympanic membrane, entry site of epithelium, extension direction, ossicular destruction, tympanosclerosis, tympanum tympani tendon involvement, stage of cholesteatoma（JOS, 2015, Japan），degree of gasification of mastoid（JOS，2015，Japan），air conductive threshold, bone conductive threshold, air-bone gap, the healing of tympanic membrane and the auditory improvement were analyzed.Result:Eighteen patients were enrolled in this study, with course of history range from 2 months to 50 years (average: 20.20±16.31) years. There were 14 cases with wet ear before operation. All patients were conformed with perforation of membranal tensa by otoendoscopic photography before operation, with nearly total in 5 ears,large size in 10 ears,medium size in 2 ears and small size in 1 ear. Ossicular erosion were found in 13 patients (malleus involved in 6, incus involved in 12 and stapes involved in 4). Thirteen patients with tendon of tensor tympani involved and 9 patients with tympanosclerosis were conformed during operation. The epithelium entered through the malleus manubrium to the promontory in 13 cases, through the edge of the perforation in 3 cases and through the incus long process to around stapes in 1 case. Cholesteatoma invasion extend to anterosuperior area in 3 cases, posterosuperior area in 3 cases,both in anterosuperior and posterosuperior area in 12 cases. The cholesteatomas classified: stage Ⅰ in 11 cases, stage Ⅱ in 7 cases. Mastoid gasification classified MC0 in 6 cases, MC1 in 10 cases and MC2 in 2 cases. The average air conductive threshold was (56.32±10.15) dB, bone conductive threshold was (20.76±6.22) dB and air-bone gap (35.56±9.84) dB.Tympanic membrane healed in all patients during following up, without recurrent of cholesteatoma, and the post-operative air conductive threshold (43.02±14.96) dB and air-bone gap (21.04±12.90)dB were improved significantly(P<0.05).Conclusion:Most of SAC were secondary to nearly total or large perforation of membranal tensa (83.33%), with relative long history of chronic otitis media (average 20.20 ± 16.31) years and otorrhea before operation. The epithelium entered mainly through the malleus manubrium to the promontory，then through edge of the perforation，by extending anterosuperior and posterosuperior area and usually accompanied with tendon of tensor tympani involved, ossicular destruction, and poor mastoid gasification and tympanosclerosis. The characteristics of SAC were different from other type of cholesteatoma which need further researches.

When should stapes surgery be performed in children?

Otosclerosis is a metabolic bone disease of the otic capsule that can cause the stapes fixation, resulting in conductive hearing loss or, in a profound sensorineural deafness threshold. Surgery is one of the possible treatments for the otosclerosis. To repair small focus of otosclerosis in the anterior crus of the stapes, in 1960, Hough suggested the implementation of a technique in which part of the anterior crus is fractured and the stapes turned. As a result, the posterior crus of the stapes is the only connection with the inner ear. In this work, the outcome of Hough's surgical technique was simulated. Based on computerized images, a finite element model of middle ear ossicles and tympanic membrane was created, as well as a model where the stapes has changed. The discretization of the tridimensional solid model was made using the ABAQUS software. The mechanical properties used were taken from the literature and adequate boundary conditions were applied. The results obtained with the Hough technique simulation were compared with a representative model of the normal ear, taking into account the displacements obtained on the central part of the stapes footplate and the maximum principal stress in the stapes crus. The results obtained are closer to the normal ear model, therefore Hough technique stands out as a good option to correct small focus of otosclerosis.

인공중이이식술(middle ear implantation)은 중고도의 감 음신경성, 전음성, 또는 혼합성 난청 환자를 치료하는 효과적 인 방법이다. 인공중이이식술은 내부 임플란트(Vibrant Sound Bridge, VSB)의 수신 장치를 통해 들어온 소리가 전기 에너지 로 변환되고 floating mass transducer(FMT)에 의해 직접 중 이 구조를 자극함으로써 외이를 거치지 않고 기존 보청기의 한계를 극복하는 효과적인 청력 회복 방법이다. 전도성 난청 혹은 혼합성 난청에서 VSB의 적응증은 1) 골도청력이 500 Hz 에서 45 dB, 1000 Hz에서 50 dB, 2000 Hz에서 65 dB, 4000 Hz에서 65 dB 이하의 난청에 적용되며, 2) FMT가 중이 구조 에 연결 가능한 해부학적 구조를 갖추어야 하며, 3) 활동성 중 이염이 없어야 한다. 처음 FMT는 침골의 장돌기에 직접 연결 하여 자장에 의해 FMT와 연결된 이소골을 진동시키도록 개발 되었으나, 이후 중이 구조물의 상태에 따라 정원창, 등골, 혹 은 난원창 등의 다른 구조에 연결하는 증례들이 보고되고 있 다. 본 저자들은 국내에서 최초로 CliP-Coupler를 이용하 여 등골에 시행한 인공중이이식술의 증례 보고를 통해 수술 방법 및 술 후 결과를 문헌 고찰과 함께 보고하는 바이다.

Objective To explore the clinical efficacy of retrograde stapes footplate fenestration for otosclerosis.Methods 103 patients (120 ears) with otosclerosis who had been treated during the period of January 2009 to March 2012 were randomly divided into a study group and a control group.The study group received retrograde stapes footplate fenestration,while the control group received routine stapes footplate fenestration.Results One week after surgical treament,the threshold of air conduction was obviously lower than the baseline (P＜0.05).3months after surgery,air-bone gap of ≤ 20 dB or ＞20 dB did not differ significantly between the two groups (P＞0.05).There was significant difference between the study group and the control group in the incidence rate of adverse reactions (5.00％ vs.35.00％,P＜0.05).Conclusions Retrograde stapes footplate fenestration can effectively improve the hearing in patients and reduce the occurrence of adverse reactions associated with surgery. Key words: Retrograde; Stapes footplate fenestratione; Otosclerosis

Objective To explore on location of the segments of the facial nerve being easy to damage in mastoid surgery.Methods Retrospective analysis was conducted according to the clinical data of 97cases with chronic suppurative otitis media performed with radical mastoidectomy (or radical mastoidectomy + tympanoplasty) from May 2010 to September 2012,and summarized the methods to locate the segment of the facial nerve being easy to damage in operation.Results ①One case of congenital defect of facial nerve canal was found in 97 cases.②The horizontal segments of the facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes.③The pyramidal segment of facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus.④The proximal part of vertical segment of the facial nerve of 97 cases were successfully located depending on combined /partial anatomic landmarks including short limb of incus,chorda tympani nerve,pyramidal eminence,eminence of the lateral semicircular canal.Conclusion The eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes,pyramidal eminence,chorda tympani nerve in the area in which the facial nerve being easy to damage are important landmarks by which the segment of facial nerve easy to damage might be located in mastoid surgery. Key words: Otitis media; Facial nerve; Mastoid surgery; Area in which the facial nerve being easy to damage

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostape dial discontinuity, with isolated congenital stapes fixation representing about one third of ossic ular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained sta pes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:448-51 Key WordsZZConductive hearing loss ㆍCongenital abnormalities ㆍStapes ㆍSurgical procedures.

Is there a “best” stapes prosthesis?

The new ictidosuchid has small trituberculate postcanines which testifies to its to insectivores. The skull is sculptured in some places, the postorbital arch is complete, the parietal crest is high, and the parietal foramen is absent. The coronoid process does not practically rise above the edge of the jaw. The carotid and Vidian canals are absent. The basipterygoid processes articulate only with the epipterygoids, the pterygoids are connected by a suture with the basisphenoid rostrum. The mesethmoid olfactory concha are ossified. The stapes is connected with the quadratum only by its edge, the major part of the distal end of the stapes is free and when the mouth is closed the ossicle contacts with the internal flank of the lower jaw, formed by the prearticulare and the articulare. On the lower edge of the dentale at its posterior end there is a concave sculptured platform; it is possible that this part of the jaw in a lying animal leaned on a substrate and functioned as the beginning of an additional system of sound transmission from the substrate through the lower aaw directly to the stapes. The palatal teeth are represented by elongated denticulate crests on the palatine, anteromedial and anterolateral groups on the pterygoids, and dentition on the transverse processes of the pterygoids.

Objective To study the microanatomy of the area in which the facial nerve being easy to damage in mastoid surgery, in order to provide microanatomical datas for the clinical works. Methods In 20 adult wet skull specimens (40 temporal bones), the segments of facial nerve and their adjacent structures in the area in which the facial nerve being easy to damage were observed according to operation of mastoid surgery. Results The length of the horizontal segment was (8.85 ± 1.01) mm (7.10-11.25 nun), the diameter was (1.88 ± 0.65) mm (1.55-1.90 mm); The angle opening towards anterior direction between horizontal segment and vertical segment was (115.50 ± 6.89°) (109.5°-128.6°); The vertical distance from the cochlearform process to this segment was (1.89 ± 0.58) mm (0.90-3.05 mm); The vertical distance from the midpoint of the base of stapes to this segment was (1.92 ± 0.52) mm (1.44-2.56 mm); The vertical distance from the head of the stapes to this segment was (2.30 ± 0.85) mm (1.97-3.11 mm); The angle towards posterior direction between horizontal segment of facial nerve and tympanic tegmen was (28.5°± 3.66°) (25.8°-31.5°); The diameter of the pyramidal segment of facial nerve was (1.89 ± 0.65) mm (1.56-1.88 mm); The distance between the su mmit of pyramidal segment of facial nerve and the apex of shor limb of incus was (2.55 ± 0.21) mm (2.10-2.90 mm); The distance from the su mmit to the eminence of the lateral semicircular canal was (2.86 ± 0.31) mm (2.23-3.56 mm); The diameter of the proximal part of vertical segment of facial nerve was (2.13 ± 0.13) mm (1.90-2.40 mm); The angle towards superior direction between verical segment of facial nerve and chorda tympani nerve was (38.60 ± 1.99°) (28.5°-52.5°); The vertical distance from the top of the pyramidal eminence to the vertical segment of the facial nerve was (2.05 ± 0.65) mm (1.85-2.36 mm). Conclusions The eminence of the lateral semicircular canal, short limb of incus, cochlearform process, tympanic tegmen, stapes, pyramidal eminence, chorda tympani nerve in the area are important landmarks to be located in mastoid surgery. The anatomic relations in this area are complicated and compact. Anatomical knowledge is very important to the surgery of this area. Key words: Facial nerve; Mastoid; Microanatomy

Konjenital anomaliler izole kemikcik anomalisi halinde veya dis kulakla kombine anomali olarak gorulebilir. Izole kemikcik anomalisi klinik pratikte cok ender olarak rastlanir. Bu anomalilerle ilgili literaturun cogunlugunu vaka takdimleri olusturmaktadir ve vaka serisi halindeki bildiriler oldukca sinirlidir. Konjenital ossikuler anomalinin tedavisi kemikciklerdeki ve oval penceredeki anomalinin varligina ve bicimine bagli olarak degisiklik gostermektedir. Bu makalede ileri derecede oval pencere anomalisi ve hareketli tabanla birlikte stapes suprastrikturunun yoklugu ile karakterize iki ender olgunu ve tedavisi literatur taramasi isiginda sunulmustur

To prepare the tissue-engineering ossicle prosthesis which contained controlled release BMP-2 and implant into the acoustic bulla of guinea-pig, and observed the osteogenesis of the prosthesis in the bulla and the effect of the prosthesis on the cochlea. The acellular bony microtubule filled with collagen containing BMP-2 as tissue-engineering prosthesis was implanted into the acoustic bulla of the guinea-pig through the retroauricular approach. The prosthesis without BMP-2 was implanted into the contralateral bulla as control. ABR of the animals was checked after surgery at different time to observe the variation of the hearing threshold. After 3 months, the osteogenesis of the prosthesis and its effect on the structure of bulla, cochlea and hair cells was observed by histological technique and silver nitrate staining method. The animals were recovered soon after surgery. The hearing threshold of the animals [(15.5 +/- 2.8) dB SPL] were increased slightly just after the surgery [(28.3 +/- 4.8) dB SPL, P<0.05], and come back completely after 3 month [(16.1 +/- 4.0) dB, P>0.05]. The prosthesis was covered with mucosa finally while the bulla and cochlea were normal in shape. The osteogenesis was occurred at the inner side of the acellular bony tube. There wasn't any abnormal hyperplasia of bone in the bulla and cochlea. The articulation between the stapes and oval window wasn't merged. The shape of the hair cells were normal and there wasn't obvious deletion of the hair cells compared with control group. The tissue-engineering ossicle prosthesis contained controlled release BMP-2 can induce osteogenesis in the bulla of the animals. This kind of material doesn't affect the shape of the bulla and the hearing threshold of the cochlea, moreover, they doesn't induce the abnormal hyperplasia of bone in the bulla and might be used to reconstruct the defects of ossicles.

Objective To explore the microanatomy of the horizontal segment of the facial nerve (FN)in temporal bone and its adjacent structures,in order to provide microanatomical datag for the clinical works.Methods In 20 adult wet skull specimens(40 temporal bones),horizontal segment of FN and their adjacent structures in temporal bones were observed according to operational layers by simulating transmagtoid approach.Results The lenglh of the horizontal segment was[(8.85±1.01)(7.10～11.25)]mm;The diameter of the horizontal segment wag[(1.88±0.65(1.55～1.90)]mm;The angle opening towards anterior direction between horizontal segment and vertical segment wag[(115.5±6.89)(109.5～128.6)]..The ansh towards posterior direction between horizontal segment of FN and tympanic tegmen wag [(28.5±3.66)(25.8～31.5)°;The vertical distance from the cochlear form process to the horizontal segment of the FN wag[(1.89±0.58)(0.90～3.05)]mm;The vertical distance from the head of the stapes to the horizontal segment of the FN wag[(2.30±0.85)(1.97～3.11)]mm;The distance between the summit of pyramidal segment of FN and the apex of shor limb of incus wag 2.55±0.21(2.10-2.90)mm;The distance between the summit of pyramidal segment of FN and the eminence of the lateral semicircuiar canal wag[(2.86±0.31)(2.23～3.56)]mm;No branching or dislocated nerve of the horizontal segment of the FN wag found in all 40 cases.Five percent(2/40)distal part of the horizontal segment of FN tracks forward lateral to the eminence of the literal semicircular canal.Conclusion Geniculate ganglion,cochlearform process,stapes,tympanic tegmen,lateral semicircular canal,incus are important landmarks by which horizontal segment of FN might be located in manipulation of mastoid;The relations of horizontal segment of FN and its adjacent structures are complicated,compact.It will be good that the manipuliter absorb a great deal of anatomical knowledge about landmarks that can be used in locating horizontal segment of FN. Key words: Temporal bone; Facial nerve; Microanatomy

R116: CT to Measure the Depth of Stapes Implant in the Vestibule

10:32 AM: Results of a Self-Crimping Stapes Prosthesis in 79 Patients

Congenital ossicular anomalies are often encountered in patients with congenital aural atresia and less frequently in patients with normal external ears. The most common site of isolated congenital ossicular anomalies is the stapes. Isolated congenital incus anomalies are rare. In June 2000, a thirteen-year-old girl visited our department complaining of hearing loss in the right ear since childhood. The external ears were normal. The pure tone audiometry showed 42 dB hearing loss with a 33 dB air-bone gap in the right ear. As the tympanic membrane was elevated during exploratory tympanotomy, the incus was found to be anomalous and resembled a small bar with one end attached to the head of the stapes while the other end was free. Both the malleus and the stapes were normal and mobile. We placed a piece of partial ossicular replacement prosthesis (Xomed 11-56362) onto the head of the stapes. We also inserted a piece of tragal cartilage between the eardrum and the prosthesis in order to prevent early protrusion of the prosthesis. The postoperative hearing gain was 15dB, and there has been no evidence of hearing deterioration over the last 12 months of follow-up.