BACKGROUND AND OBJECTIVES: The aim of this study is to analyze the causes of recurrent conductive hearing loss following stapedotomy, and then the final hearing results. SUBJECTS AND METHOD: This study was a retrospective chart review of 6 patients who underwent revision stapedotomy for recurrent or persistent conductive hearing loss after primary stapedotomy. The intraoperative findings, surgical outcome including audiologic data and complications were noted. RESULTS: Obstruction of oval window fenestration was demonstrated in 5 patients (83.3%), short prosthesis in 4 patients (66.7%), incus erosion in two patients (33.3%) and granulation around prosthesis and stapes in one patient. Successful hearing improvements, air-bone gap (ABG) reduced to 20 dB or less, were achieved in 5 ears (83.3%). There were no patients who noted sensorineural hearing loss and other significant complications after surgery. CONCLUSION: More than 83% of revision stapedotomy cases have had successful closure of their ABG. The most common problem was obstruction of oval window fenestration (83.3%).
Ear ; Hearing ; Hearing Loss ; Hearing Loss, Conductive ; Hearing Loss, Sensorineural ; Humans ; Incus ; Prostheses and Implants ; Reoperation ; Retrospective Studies ; Stapes ; Stapes Surgery

Cochlear Implantation ; Ear, Inner/surgery* ; Hearing Loss, Sensorineural ; Humans

BACKGROUND AND OBJECTIVES: Stapedial fixation is most commonly found in congenital anomaly of middle ear. Congenital middle ear anomaly without anomaly of the auricle and inner ear is rare. The surgery of stapedial fixation has evolved during the last 50 years from total to partial stapedectomy, and finally to stapedotomy. Stapedotomy is less likely to induce iatrogenic inner ear lesions and results in better hearing in the higher frequencies than stapedectomy. In recent years, stapedectomy has increasing tendency to be replaced by stapedotomy. This study was carried out to analyse clinical features of stapedial fixation and evaluate the degree of the auditory improvement, and also to analyse the factors affecting the results after stapedotomy. MATERIALS AND METHOD: From Jan. 1992 to Aug. 2001, we analysed 25 cases (23 patients) of stapedotomy operated by one surgeon for stapedial fixation at Asan Medical Center. The clinical features, preoperative and postoperative audiologic findings, postoperative complication and factors affecting the results were analysed. RESULTS: Preoperative mean bone and air conduction thresholds were 26.5 dB, 64.0 dB, respectively and mean air-bone gap was 36.5 dB. After stapedotomy, mean bone and air conduction thresholds were 24.9 dB, 37.0 dB, respectively at the last audiologic follow-up. In one case, sensorineural hearing loss was observed. There were no significant differences of results associated with bilaterality, length of piston wire and con-commitent other ossicular anomaly. CONCLUSION: Stapedotomy is effective and safe for stapedial fixation. But there is a need for carefulness and meticulousness because of complication. There may need various operative trials and larger scale studies to study about factors affecting the results after stapedotomy.
Chungcheongnam-do ; Ear, Inner ; Ear, Middle ; Follow-Up Studies ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Postoperative Complications ; Stapes Surgery

BACKGROUND: In congenital stapedial fixation, hearing could be restored by surgery on stapedial footplate. Stapes surgery was not a common operative method especially in children due to reported leakage of cerebrospinal fluid(perilymph gusher) and postoperative sensorineural hearing loss as well as low prevalence of stapedial fixation in Korea. OBJECTIVE: To evaluate the clinical manifestations and surgical results of congenital stapedial fixation. MATERIALS AND METHODS: From Dec. 1980 to Mar. 1996, authors experienced 17 cases of stapes surgery for congenital stapedial fixation in 14 children at Seoul National University Hospital. The clinical manifestations, preoperative and postoperative audiologic findings and complications were analyzed. In 10 ears, total stapedectomies were performed and partial stapedectomies were performed in other 3 ears. In the remaining 4 ears, stapedotomies were performed. RESULTS: Preoperative mean bone and air conduction thresholds were 15 dB, 62 dB respectively and mean air-bone gap was 47 dB. After stapes surgery, mean bone and air conduction thresholds were 12 dB, 32 dB respectively at the last audiologic follow-up. No perilymph gushers or significant sensorineural hearing loss were encountered. CONCLUSION: Stapes surgery is a safe and effective method in the management of congenital stapedial fixation.
Child* ; Ear ; Follow-Up Studies ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Korea ; Perilymph ; Prevalence ; Seoul ; Stapes Surgery

BACKGROUND AND OBJECTIVES: Hearing loss is the main symptom of otosclerosis. Stapes surgery could restore the hearing ability, but the amount of restoration was changed as time passed. The aims of this study were to analyze the outcome of primary stapes surgery in otosclerosis and to compare hearing changes in stapedectomy and stapedotomy group. SUBJECTS AND METHOD: This study involved 221 ears, which were operated on for otosclerosis in Seoul National University Hospital from 1983 to 2005. We analyzed the hearing results of stapes surgery regarding air conduction, bone conduction, air-bone gap using the operation methods in preoperative, postoperative 1, 3, 6, 12, 24 months and after 36-months period. RESULTS: Stapedectomy was performed in 75 ears and stapedotomy in 146 ears. There were no differences of mean age, preoperative hearing between stapedectomy and stapedotomy group. In the postoperative period, hearing thresholds were significantly decreased compared with preoperative period in each group. The stapedectomy group showed more improvement of air conduction and reduction of AB gap than the stapedotomy group. Results of bone conduction showed no difference after the postoperative 12 months period between the two groups. Hearing improvement went on upto postoperative 12 months. Development of sensorineural hearing loss was found in two patients (2.7%) in the stapedectomy group and in one patient (0.68%) in the stapedotomy group. CONCLUSION: Stapedectomy showed better hearing results, but had more risks of sensorineural hearing loss in this study.
Bone Conduction ; Ear ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Otosclerosis ; Postoperative Period ; Preoperative Period ; Stapes ; Stapes Surgery

Adult ; Cochlear Implantation ; Female ; Hearing Loss, Sensorineural ; etiology ; surgery ; Humans ; Meniere Disease ; complications ; surgery

Cochlear Implantation ; Cochlear Implants/adverse effects* ; Hearing Loss, Sensorineural/surgery* ; Humans ; Tinnitus/surgery* ; Treatment Outcome

Otosclerosis is a localized disorder of bone metabolism involving the endochondral bone of the otic and labyrinthine capsule. Both "advanced" and "very advanced" otosclerosis refer to the state of otosclerotic involvement of the otic capsule, which has progressed to result in profound deafness with undetectable bone and air conduction thresholds. Shea et al. estimated that 1.6% of patients with otosclerosis had developed profound hearing losses, and that hearing improvements after stapes surgeries in these patients were lower than the case of "not-advanced" otosclerosis. Stapedectomy and hearing aid amplification could be tried, but cochlear implantation is an established intervention for patients with profound sensorineural hearing loss due to otosclerosis. Although the reported results of cochlear implantations in otosclerosis patients are not significantly different from those of other cochlear implantees not affected by otosclerosis, in former conditions, potential ossification of cochlea, facial nerve stimulation, and instability of the results might take place. We report a case of otosclerosis histologically diagnosed for the first time here in Korea, and for which cochlear implantation was successfully performed.
Cochlea ; Cochlear Implantation ; Cochlear Implants ; Deafness ; Facial Nerve ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Hypogonadism ; Korea ; Mitochondrial Diseases ; Ophthalmoplegia ; Otosclerosis ; Stapes Surgery

The repair of congenital aural atresia remains one of the most challenging otologic procedures because of the scarcity of surgical landmarks, the complexity and the variety of the temporal bone anatomy, and the limited space for reconstruction. The risks of facial nerve injury and profound sensorineural hearing loss following atresia surgery are common concerns. Furthermore, the rarity of the disease makes it difficult to improve surgical learning. Image-guided surgery may aid otologic surgeons in repairing atresia as it allows identifying the exact position of surgical instruments in relation to the specific anatomy. To our knowledge, there have been no published reports on image-guided atresia surgery in Korea. Herein, we report a case of congenital aural atresia, which was repaired using image-guided surgical technique.
Facial Nerve Injuries ; Hearing Loss, Sensorineural ; Korea ; Learning ; Surgery, Computer-Assisted* ; Surgical Instruments ; Temporal Bone

BACKGROUND: The use of intraoperative brainstem auditory evoked potential (BAEP) has reduced the incidence of sensorineural hearing loss (SNHL) after microvascular decompression (MVD). This complication occurs due to direct compressive and/or stretching injury of the cochlear nerve or to indirect compression of the perineural vasculature during cerebellar retraction. The aim of this study was to evaluate the effect of thiopental sodium on SNHL after MVD for hemifacial spasm. METHODS: 94 hemifacial spasm patients with normal hearing function preoperatively and who underwent MVD under intraoperative BAEP monitoring were enrolled in this study. Patients were randomly divided into two groups. 52 patients were administered placebo (control group) and 42 patients were administered thiopental sodium 5 mg/kg intravenously 5 minutes before cerebellar retraction (thiopental group). The effects of thiopental on intraoperative BAEP changes and postoperative hearing functional outcomes were sought. Incidence and degree of postoperative SNHL were evaluated by pure tone audiometry threshold analysis. RESULTS: Maximal changes in intraoperative BAEP parameters did not differ between the two groups, and neither did the incidence nor degree of SNHL. In the control group, 4 transient and 4 permanent postoperative SNHL, including 2 deaf patients, occurred with an overall incidence of 15.4%. In the thiopental group, 2 transient and 1 permanent postoperative SNHL occurred, with an overall incidence of 7.1%. CONCLUSIONS: Thiopental sodium administered prior to cerebellar retraction might reduce the incidence of postoperative hearing loss.
Audiometry ; Cochlear Nerve ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing* ; Hemifacial Spasm ; Humans ; Incidence ; Microvascular Decompression Surgery* ; Thiopental*