BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive cond...BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive conductive hearing loss that typically began in the early years of life.CASE SUMMARY Herein,we report a case of a 37-year-old female with an isolated stapedial suprastructure fixation.The patient presented with unusual fluctuating auditory symptoms of tinnitus,ear fullness and mixed hearing loss.Pre-operative temporal bone computed tomography findings and operative findings revealed an isolated stapedial suprastructure fixation with monopod stapes caused by elongated pyramidal eminence.The hearing threshold recovered completely,and fluctuating auditory symptoms disappeared after the surgery.CONCLUSION This is the first report of stapedial suprastructure fixation with fluctuating auditory symptoms.Successful results are expected with surgical treatment.展开更多
Stapes fracture causes hearing loss and instability in the middle ear hearing system(MEHS). The material used in the stapes reconstruction restores stapes, but the effects of the nonlinear material parameters on the s...Stapes fracture causes hearing loss and instability in the middle ear hearing system(MEHS). The material used in the stapes reconstruction restores stapes, but the effects of the nonlinear material parameters on the stability of the MEHS are still unknown. To address this challenge, the nonlinear dynamic response and stability of the stapes reconstruction are investigated using a multi-degree-of-freedom mechanical model. The material parameters of the implant are tentatively determined by analyzing the natural frequencies of the undamped system. The dynamical properties of the MEHS are characterized under different external excitations. The approximate solution of the MEHS near the resonant frequency is derived through the multiple-time-scale method(MTSM). The results show that the nonlinear stiffness of the material has little influence on the MEHS in the healthy state, but it causes resonant phenomena between the ossicle and the implant in the pathological state.展开更多
Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patie...Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patients(35 females,mean age=46.8 years).Intervention:All patients underwent stapedotomy.The validated Portuguese version of the“Hyperacusis Questionnaire”(HQ)was administered before and two weeks and one month after surgery.Results:No hyperacusis was reported by any patient before surgery.At two weeks after surgery,all patients experienced hyperacusis,with a mean HQ at 16.88±6.54(range 4e25).One month after surgery,hyperacusis had already resolved in most patients.Gender,preoperative presentation or surgeon had no influence on HQ scores(p>0.05).Patients with previous contralateral stapedotomy showed lower HQ scores(p=0.001).Audiological parameters improvement measured at one month after surgery(PTA,SRT and contralateral SRT)were associated with HQ higher scores.Conclusion:This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery.The HQ highest scores were registered among patients with the highest audiological gain after surgery.This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.展开更多
Objective: to study the nursing measures for otosclerosis patients treated with CO2 laser assisted stapes prosthesis. Methods: 85 patients with otosclerosis treated in our hospital from 2018 to 2020 were selected as t...Objective: to study the nursing measures for otosclerosis patients treated with CO2 laser assisted stapes prosthesis. Methods: 85 patients with otosclerosis treated in our hospital from 2018 to 2020 were selected as the research object. All the selected 85 patients were treated with CO2 laser-assisted artificial stapes technique. 85 patients were randomly divided into control group (n = 42) and experimental group (n = 43). The control group received routine nursing while the experimental group received perioperative nursing cooperation. Results: the incidence of complications in the experimental group was significantly lower than that in the control group, and the nursing satisfaction of the patients in the experimental group was significantly higher than that in the control group. The data of each index group were compared, P < 0.05. Conclusion: in the process of CO2 laser-assisted artificial stapes treatment for patients with otosclerosis, perioperative nursing cooperation from preoperative, intraoperative and postoperative can effectively reduce the incidence of complications of patients and improve patients' nursing satisfaction.展开更多
Background:Stapes prostheses play a crucial role in improving auditory performance and facilitating the patient's reintegration into social life.However,determining the ideal characteristics of a prosthesis and id...Background:Stapes prostheses play a crucial role in improving auditory performance and facilitating the patient's reintegration into social life.However,determining the ideal characteristics of a prosthesis and identifying the best commercially available option remain challenging.This study aims to compare the outcomes of two different types of prostheses:the MatriX Stapes Prosthesis and the new mAXIS Stapes Prosthesis.Methods:A prospective study was conducted on patients diagnosed with suspected otosclerosis who underwent stapedotomy,receiving either the MatriX or m AXIS prosthesis randomly during surgery.Postoperative follow-ups were conducted for at least one year.Audiometric evaluations were analyzed using statistical tests.Additionally,a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses(PRISMA)statement.Results:The prospective study included 84 patients,divided into two groups(G1:MatriX,G2:mAXIS).The auditory results were satisfactory for both prostheses,demonstrating their effectiveness in improving hearing thresholds.We observed a gain for air conduction threshold of 26.2 dB vs 21.2 dB with an ABG closure of 20.7 dB vs and 21.2 dB in G1 and G2 respectively.The literature review encompassed 15studies,revealing overall positive outcomes with different prosthetic materials.Conclusions:The study revealed effective auditory improvement with both prostheses,yet no statistically significant differences in air-bone gap closure or average hearing gain.Titanium emerged as the preferred material due to its biocompatibility,lightweight nature,and stability under magnetic resonance imaging.The mAXIS prosthesis is introduced as a cost-effective alternative with favorable intraoperative features.展开更多
Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any commo...Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.展开更多
Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objec...Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.展开更多
Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of su...Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.Methods: A retrospective study involving review of clinical data of 227 patients(256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography(CT) data, surgical records and videos.Results: Aberration involving intratemporal facial nerve was found in 82/256 ears(32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window(50/82 ears, 60.98%), bifurcation(3/82 ears, 3.66%) and transverse over the promontory(3/82 ears, 3.66%), counting for 68.29%(56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears(92.68%) and atresia or stenosis of the oval window in 27/82 ears(32.93%). In 9/82 ears(10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis(TORP) implantation and Vibrant Soundbridge(VSB) implantation.Conclusion: The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.展开更多
Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it rem...Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it remains gold standard for cases of extensive necrosis,incus dislocation,or epitympanic fixation.Modern heat-crimping pistons make surgery easier and safer.This study focuses on our experience with this technique.Methods:Retrospective analysis of patient’s files and pre-and post-operative audiograms,for cases of surgically treated otosclerosis with malleostapedotomy.Results:Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019.Amongst them there were 10 revision surgeries and 2 primary cases.75%had incus long-process necrosis,17%had epitympanic fixation and one had a history of incus transposition.Nine patients(75%)had closure of air-bone gap(ABG)of<10 dB(p<0.001)and 11(92%)had a threshold of 20 dB(p<0.001).Mean pre-operative ABG was 31 dB(15 dBe55 dB),and mean post-operative ABG was 7 dB(0 dBe21 dB;p<0.001).There was no sensorineural hearing loss nor any other post-operative complication.Conclusions:Malleostapedotomy is a safe and reliable technique,allowing an ABG closure comparable to conventional incus to vestibule prosthesis.It remains the preferred technique whenever the incus cannot be used.展开更多
Reparative granuloma in the oval window region is an uncommon complication of stapes surgery, which usually develops within one to eight weeks after operation and causes a sudden hearing loss and disturbance of balanc...Reparative granuloma in the oval window region is an uncommon complication of stapes surgery, which usually develops within one to eight weeks after operation and causes a sudden hearing loss and disturbance of balance. It may also cause otalgia. Because of its rarity, no single centre would be able to give conclusive evidence regarding this complication. Hence we would like to report our experience and hope to get a better understanding regarding the stapes surgery induced granulation.展开更多
Background: To evaluate hearing outcome, operation time and post-operative hospital stay after primary stapedoplasty with three different techniques: manual microsurgical, microdrill-assisted, and microdrill- and lase...Background: To evaluate hearing outcome, operation time and post-operative hospital stay after primary stapedoplasty with three different techniques: manual microsurgical, microdrill-assisted, and microdrill- and laser-assisted technique. Methods: A retrospective analysis of 150 consecutive cases of primary otosclerosis was operated by one surgeon. The patients were divided into three groups depending on the utilized surgical techniques: a fully manual microsurgical stapedoplasty (n = 56), microdrill-assisted stapedoplasty (n = 32), and microdrill- and laser-assisted stapedoplasty (n = 62). The mean pre- and post-operative air-bone gap was calculated by using pre- and post-operative mean pure tone air- and bone-conduction thresholds at 500, 1000, 2000 and 4000 Hz. Results: There were no statistically significant differences in the hearing outcome between the groups. The closure of air-bone gap and the improvement of the hearing were demonstrated in all study groups. Introduction of diode laser for stapes surgery resulted in significantly reduced operation time (about one-third) and the increase in the completion of surgery from 81.5% to 96.7%. At the same time, the rate of complications stayed low and hospital stay dropped from three days to one day. There were no major post-operative complications in any study groups. Conclusions: Application of diode laser in stapes surgery significantly reduced operation time and increased completion rate of surgery. No statistically significant difference was found between three surgical techniques regarding hearing outcome.展开更多
Human temporal bone specimens are used in experiments to measure the sound transfer function of the middle ear.This standard method for the development of middle ear implants requires temporal bones that possess appro...Human temporal bone specimens are used in experiments to measure the sound transfer function of the middle ear.This standard method for the development of middle ear implants requires temporal bones that possess appropriate mechanical properties and structural stability and are free from pathological conditions.A laser Doppler vibrometer is commonly employed to measure the vibration of the stapes footplate.These experiments are typically conducted in the middle ear by leaving the inner ear intact,exposing the stapes footplate through the tympanic cavity,and directing the laser beam onto the footplate.However,previous studies have shown that the influence of inner ear impedance on the middle ear transfer function cannot be ignored,and any surgical manipulation may cause a change in inner ear pressure,resulting in instability in the middle ear transfer function.Therefore,this study aims to eliminate the influence of the inner ear and to establish a new experimental method in human temporal bone specimens that is more suitable for the study of sound conduction in middle ear implants.As a result,a range for middle ear transfer function was developed,which serves as a reference for assessing the conformity of temporal bone specimens to experimental standards,and the stability of this range was demonstrated under experimental conditions.展开更多
文摘BACKGROUND Stapes ankylosis is a rare cause of conductive hearing loss,and stapes suprastructure fixation is extremely rare with fewer than 30 reported cases.Patients usually visit the clinic with non-progressive conductive hearing loss that typically began in the early years of life.CASE SUMMARY Herein,we report a case of a 37-year-old female with an isolated stapedial suprastructure fixation.The patient presented with unusual fluctuating auditory symptoms of tinnitus,ear fullness and mixed hearing loss.Pre-operative temporal bone computed tomography findings and operative findings revealed an isolated stapedial suprastructure fixation with monopod stapes caused by elongated pyramidal eminence.The hearing threshold recovered completely,and fluctuating auditory symptoms disappeared after the surgery.CONCLUSION This is the first report of stapedial suprastructure fixation with fluctuating auditory symptoms.Successful results are expected with surgical treatment.
基金Project supported by the National Natural Science Foundation of China (Nos. 12072222, 12132010,12021002, 11991032, and 12372019)the State Key Laboratory of Mechanical Behavior and System Safety of Traffic Engineering Structures of China (No. SKLTESKF1901)the Aeronautical Science Foundation of China (No. ASFC-201915048001)。
文摘Stapes fracture causes hearing loss and instability in the middle ear hearing system(MEHS). The material used in the stapes reconstruction restores stapes, but the effects of the nonlinear material parameters on the stability of the MEHS are still unknown. To address this challenge, the nonlinear dynamic response and stability of the stapes reconstruction are investigated using a multi-degree-of-freedom mechanical model. The material parameters of the implant are tentatively determined by analyzing the natural frequencies of the undamped system. The dynamical properties of the MEHS are characterized under different external excitations. The approximate solution of the MEHS near the resonant frequency is derived through the multiple-time-scale method(MTSM). The results show that the nonlinear stiffness of the material has little influence on the MEHS in the healthy state, but it causes resonant phenomena between the ossicle and the implant in the pathological state.
文摘Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patients(35 females,mean age=46.8 years).Intervention:All patients underwent stapedotomy.The validated Portuguese version of the“Hyperacusis Questionnaire”(HQ)was administered before and two weeks and one month after surgery.Results:No hyperacusis was reported by any patient before surgery.At two weeks after surgery,all patients experienced hyperacusis,with a mean HQ at 16.88±6.54(range 4e25).One month after surgery,hyperacusis had already resolved in most patients.Gender,preoperative presentation or surgeon had no influence on HQ scores(p>0.05).Patients with previous contralateral stapedotomy showed lower HQ scores(p=0.001).Audiological parameters improvement measured at one month after surgery(PTA,SRT and contralateral SRT)were associated with HQ higher scores.Conclusion:This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery.The HQ highest scores were registered among patients with the highest audiological gain after surgery.This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.
文摘Objective: to study the nursing measures for otosclerosis patients treated with CO2 laser assisted stapes prosthesis. Methods: 85 patients with otosclerosis treated in our hospital from 2018 to 2020 were selected as the research object. All the selected 85 patients were treated with CO2 laser-assisted artificial stapes technique. 85 patients were randomly divided into control group (n = 42) and experimental group (n = 43). The control group received routine nursing while the experimental group received perioperative nursing cooperation. Results: the incidence of complications in the experimental group was significantly lower than that in the control group, and the nursing satisfaction of the patients in the experimental group was significantly higher than that in the control group. The data of each index group were compared, P < 0.05. Conclusion: in the process of CO2 laser-assisted artificial stapes treatment for patients with otosclerosis, perioperative nursing cooperation from preoperative, intraoperative and postoperative can effectively reduce the incidence of complications of patients and improve patients' nursing satisfaction.
文摘Background:Stapes prostheses play a crucial role in improving auditory performance and facilitating the patient's reintegration into social life.However,determining the ideal characteristics of a prosthesis and identifying the best commercially available option remain challenging.This study aims to compare the outcomes of two different types of prostheses:the MatriX Stapes Prosthesis and the new mAXIS Stapes Prosthesis.Methods:A prospective study was conducted on patients diagnosed with suspected otosclerosis who underwent stapedotomy,receiving either the MatriX or m AXIS prosthesis randomly during surgery.Postoperative follow-ups were conducted for at least one year.Audiometric evaluations were analyzed using statistical tests.Additionally,a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses(PRISMA)statement.Results:The prospective study included 84 patients,divided into two groups(G1:MatriX,G2:mAXIS).The auditory results were satisfactory for both prostheses,demonstrating their effectiveness in improving hearing thresholds.We observed a gain for air conduction threshold of 26.2 dB vs 21.2 dB with an ABG closure of 20.7 dB vs and 21.2 dB in G1 and G2 respectively.The literature review encompassed 15studies,revealing overall positive outcomes with different prosthetic materials.Conclusions:The study revealed effective auditory improvement with both prostheses,yet no statistically significant differences in air-bone gap closure or average hearing gain.Titanium emerged as the preferred material due to its biocompatibility,lightweight nature,and stability under magnetic resonance imaging.The mAXIS prosthesis is introduced as a cost-effective alternative with favorable intraoperative features.
文摘Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.
基金Funded by Research Section,All India Institute of Medical Sciences,New Delhi,India,File No.F.8-522/A-522/2017/RS(Project code No:A-522)Dated 19th September 2017
文摘Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.
基金supported by Beijing Municipal Science&Technology Commission(No.2171100001017079)for Prof. Shouqin Zhao
文摘Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.Methods: A retrospective study involving review of clinical data of 227 patients(256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography(CT) data, surgical records and videos.Results: Aberration involving intratemporal facial nerve was found in 82/256 ears(32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window(50/82 ears, 60.98%), bifurcation(3/82 ears, 3.66%) and transverse over the promontory(3/82 ears, 3.66%), counting for 68.29%(56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears(92.68%) and atresia or stenosis of the oval window in 27/82 ears(32.93%). In 9/82 ears(10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis(TORP) implantation and Vibrant Soundbridge(VSB) implantation.Conclusion: The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.
文摘Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it remains gold standard for cases of extensive necrosis,incus dislocation,or epitympanic fixation.Modern heat-crimping pistons make surgery easier and safer.This study focuses on our experience with this technique.Methods:Retrospective analysis of patient’s files and pre-and post-operative audiograms,for cases of surgically treated otosclerosis with malleostapedotomy.Results:Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019.Amongst them there were 10 revision surgeries and 2 primary cases.75%had incus long-process necrosis,17%had epitympanic fixation and one had a history of incus transposition.Nine patients(75%)had closure of air-bone gap(ABG)of<10 dB(p<0.001)and 11(92%)had a threshold of 20 dB(p<0.001).Mean pre-operative ABG was 31 dB(15 dBe55 dB),and mean post-operative ABG was 7 dB(0 dBe21 dB;p<0.001).There was no sensorineural hearing loss nor any other post-operative complication.Conclusions:Malleostapedotomy is a safe and reliable technique,allowing an ABG closure comparable to conventional incus to vestibule prosthesis.It remains the preferred technique whenever the incus cannot be used.
文摘Reparative granuloma in the oval window region is an uncommon complication of stapes surgery, which usually develops within one to eight weeks after operation and causes a sudden hearing loss and disturbance of balance. It may also cause otalgia. Because of its rarity, no single centre would be able to give conclusive evidence regarding this complication. Hence we would like to report our experience and hope to get a better understanding regarding the stapes surgery induced granulation.
文摘Background: To evaluate hearing outcome, operation time and post-operative hospital stay after primary stapedoplasty with three different techniques: manual microsurgical, microdrill-assisted, and microdrill- and laser-assisted technique. Methods: A retrospective analysis of 150 consecutive cases of primary otosclerosis was operated by one surgeon. The patients were divided into three groups depending on the utilized surgical techniques: a fully manual microsurgical stapedoplasty (n = 56), microdrill-assisted stapedoplasty (n = 32), and microdrill- and laser-assisted stapedoplasty (n = 62). The mean pre- and post-operative air-bone gap was calculated by using pre- and post-operative mean pure tone air- and bone-conduction thresholds at 500, 1000, 2000 and 4000 Hz. Results: There were no statistically significant differences in the hearing outcome between the groups. The closure of air-bone gap and the improvement of the hearing were demonstrated in all study groups. Introduction of diode laser for stapes surgery resulted in significantly reduced operation time (about one-third) and the increase in the completion of surgery from 81.5% to 96.7%. At the same time, the rate of complications stayed low and hospital stay dropped from three days to one day. There were no major post-operative complications in any study groups. Conclusions: Application of diode laser in stapes surgery significantly reduced operation time and increased completion rate of surgery. No statistically significant difference was found between three surgical techniques regarding hearing outcome.
文摘Human temporal bone specimens are used in experiments to measure the sound transfer function of the middle ear.This standard method for the development of middle ear implants requires temporal bones that possess appropriate mechanical properties and structural stability and are free from pathological conditions.A laser Doppler vibrometer is commonly employed to measure the vibration of the stapes footplate.These experiments are typically conducted in the middle ear by leaving the inner ear intact,exposing the stapes footplate through the tympanic cavity,and directing the laser beam onto the footplate.However,previous studies have shown that the influence of inner ear impedance on the middle ear transfer function cannot be ignored,and any surgical manipulation may cause a change in inner ear pressure,resulting in instability in the middle ear transfer function.Therefore,this study aims to eliminate the influence of the inner ear and to establish a new experimental method in human temporal bone specimens that is more suitable for the study of sound conduction in middle ear implants.As a result,a range for middle ear transfer function was developed,which serves as a reference for assessing the conformity of temporal bone specimens to experimental standards,and the stability of this range was demonstrated under experimental conditions.
