Humans ; Stapes ; Otosclerosis/surgery* ; Ossicular Prosthesis ; Stapes Surgery ; Incus

Humans ; Otosclerosis/surgery* ; Stapes ; Stapes Surgery/adverse effects* ; Arteries

BACKGROUND AND OBJECTIVES: A free-beam-type CO₂ laser, which use a micromanipulator mounted on a microscope as the delivery system, has the merit of not being affected by hand tremor at the time of shooting. However, this delivery system has several disadvantages, including a restricted operation range and a risk of incorrect focusing. A fiber-type CO₂ laser uses a hand-held delivery system and has the opposite merits and demerits. We compared the results of stapes surgery with free-beam and fiber type delivery systems. SUBJECTS AND METHODS: The study enrolled 36 patients who underwent stapedotomy with free-beam- (n=26) or fiber- (n=10) type CO₂ lasers. The air-bone (AB) gap closure, bone conduction (BC) change, and operating time were evaluated. The AB gap closure was calculated by subtracting the preoperative BC thresholds from the postoperative air conduction thresholds. The BC change was calculated by subtracting the postoperative BC thresholds from the preoperative BC thresholds. RESULTS: The mean operating time was significantly (p=0.035) shorter in the fiber-type group (72.5±8.2 min) than in the free-beam-type group (80.5±11.4 min). The mean AB gap closure did not differ significantly (p=0.297) between the free-beamand fiber-type groups (5.8±10.1 and 1.4±6.8 dB, respectively). The mean BC change did not differ significantly (p=0.873) between the free-beam- and fiber-type groups (2.4±6.9 and 2.8±5.3 dB, respectively). The hearing outcomes did not differ significantly between the two groups. CONCLUSIONS: Operating times were significantly shorter using the fiber-type CO₂ laser, while hearing outcomes did not differ significantly between the two groups.
Bone Conduction ; Hand ; Hearing ; Humans ; Otosclerosis ; Stapes Surgery* ; Stapes* ; Tremor

BACKGROUND AND OBJECTIVES: Tympanosclerosis is a nonspecific and irreversible result of chronic inflammation or infection of the middle ear. However, there remains disagreement about how best to surgically treat tympanosclerotic ossicular fixation, with the controversy over its management when stapes is involved. The aim of this study was to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, which in turn would establish better surgical treatment of tympanosclerotic ossicular fixation. SUBJECTS AND METHODS: In this prospective study conducted from Mar 2000 to Dec 2007, 38 patients with tympanosclerosis who had undergone surgical treatment were evaluated. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed. RESULTS: Operative findings showed stapes fixation is the most common. In 8 patients (21.1%), stapes was mobile, while, in the remaining 30 patients (78.9%), stapes fixation was found. In all cases with stapes fixation, stapes mobilization was possible. Following hearing result reporting guideline by the Korean Otological Society, the success rate of middle ear surgery was 68.4% (26 of 38 patients). In cases with stapes fixation, the success rate was 66.6% (20 of 30 patients), while, in cases with no stapes fixation, the success rate was 75.0% (6 of 8 patients). However, there was no statistical significance between the two groups. CONCLUSION: Stapes fixation was found in 78.9% of tympanosclerotic ossicular fixation. In management of tympanosclerotic stapes fixation, meticulous excision of tympanosclerotic plaques and removal of new bone formation around stapes footplate after adequate exposure could achieve a relatively good hearing result without stapes surgery.
Ear, Middle ; Hearing ; Humans ; Inflammation ; Myringosclerosis ; Ossicular Replacement ; Osteogenesis ; Prospective Studies ; Stapes ; Stapes Mobilization ; Stapes Surgery

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the results of malleostapedotomy as primary surgical procedure in stapes fixation. SUBJECTS AND METHOD: This study was a retrospective chart review of 12 patients who underwent primary malleostapedotomy for conductive hearing loss. The intraoperative findings, surgical outcomes including audiologic data and complications were analyzed. RESULTS: Nine patients had ossicular fixation with ossicular anomalies and 3 patients had ossicular fixation alone. The median length of piston wire was 5.5 mm in total length. The preoperative mean bone and air-conduction thresholds were 57.5+/-8.8 (mean+/-SD) dB, 19.7+/-10.3 dB, respectively, and the mean air-bone gap (ABG) was 44.6+/-13.2 dB. After malleostapedotomy, hearings were improved and mean postoperative ABG was 11.1+/-11.3 dB. In eight patients (66.7%), ABG was reduced to 20 dB or less. There was no intraoperative or postoperative complication except for mild postoperative vertigo for 1 or 2 days. CONCLUSION: Malleostapedotomy can be a safe and effective surgical procedure as an alternative of incus stapedotomy in certain cases of absence or anomalous incus long process, and/or immobile incus in patients with stapes fixation.
Hearing Loss, Conductive ; Humans ; Incus ; Postoperative Complications ; Retrospective Studies ; Stapes ; Stapes Surgery ; Vertigo

Postoperative vertigo can occur after stapes surgery in approximately 5% of the patients, which more commonly presents immediately after surgery rather than in the delayed period. Isolated delayed vertigo after stapes surgery is commonly related to perilymphatic fistula. Herein we report a 36-year-old female patient who developed positional vertigo 18 days after stapes surgery demonstrating severe geotropic horizontal positional nystagmus on both sides during supine roll test. This patient was eventually diagnosed as the horizontal semicircular canal benign paroxysmal positional vertigo (BPPV) on the left side. This is a rare case of delayed vertigo following stapes surgery caused by BPPV rather than perilymphatic fistula.
Adult ; Female ; Fistula ; Humans ; Nystagmus, Physiologic ; Otosclerosis ; Semicircular Canals ; Stapes Surgery ; Stapes ; Vertigo

OBJECTIVE: To investigate the feasibility of the treatment of otosclerosis using laser stapedotomy with mini incision in the external auditory meatus. METHOD: Thirteen patients(15 ears) with otosclerosis evidence on clinic history. They were all operated using the laser assisted stapedotomy by mini incision in external auditory meatus because of the wide straight canal. Laser resection the tendo musculistapedius and anterior and postrior arch, breaking the articulatioincudostapedia, removing the stapes superstructure, making a hole of 6mm diameter in the rear of stapes footplate by laser drilling, implanting the corresponding length Piston artificial ossicle. RESULT: All the surgeries were successful and the operation time was about one hour. There was only one patient manifested vertigo and nausea after the operation. But the symptoms improved three days later after the expectant treatment. All the incisions were healed in the externals. There was significant difference between the preoperative and postoperative PTA. The air conduct improved in every frequent and the bone conduct improved in 1 kHz, 2 kHz and 4 kHz. CONCLUSION Laser assisted stapedotomy by mini incision in the external auditory meatus in patients having wide straight canal with otosclerosis can shorten the operation time, minimize the tissue damage, fasten the healing of the incision and reduce the complications postoperatively. In addition, the mini incision is beauty and easy to nurse.
Ear Canal ; surgery ; Humans ; Lasers ; Otosclerosis ; surgery ; Postoperative Complications ; Postoperative Period ; Prostheses and Implants ; Stapes ; Stapes Surgery ; Treatment Outcome

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

BACKGROUND AND OBJECTIVES: Many studies have demonstrated that stapedotomy is a successful means of improving hearing for stapes fixation. The aim of this study was to analyze the pre and post-operative hearing improvements and causes of unsuccessful cases after stapedotomy. SUBJECTS AND METHOD: We reviewed the medical records and video recordings of 38 patients(39 ears) retrospectively who underwent stapedotomy between January 1994 and March 2006. Beside stapes fixation, patients, having other ossicular anomaly, stapes fixation in chronic middle ear disease and past history of ear surgery, were excluded. Patient ages ranged from 6 to 60 years, with the patients consisting of 15 males, 16 ears and 23 females, 23 ears. Observation ranged from 8 to 50 months and the mean observation time was 15.4+/-11.6 months. Hearing improvements at the final examination were designated as successful when air-bone gap was reduced to 20 dB or less. RESULTS: Pre-operative mean bone and air conduction thresholds were 21.6+/-10.8 (mean+/-SD) dBHL, 53.4+/-12.1 dBHL respectively and mean air-bone gap were 31.8+/-8.8 dB. After stapedotomy, mean bone and air conduction thresholds were 17.6+/-9.0 dBHL, 29.6+/-11.9 dBHL respectively and mean air-bone gap were 11.5+/-7.1dB at the last audiologic follow-up. Successful hearing improvements were achieved in 36 ears (92.3%). Three patients underwent revision surgery. CONCLUSION: This study suggests that stapes surgery is successful for hearing improvement for stapes fixation with unknown etiology.
Ear ; Ear, Middle ; Female ; Follow-Up Studies ; Hearing* ; Humans ; Male ; Medical Records ; Retrospective Studies ; Stapes Surgery ; Stapes* ; Video Recording

Conductive hearing loss is a condition that can be corrected surgically in most cases. Stapedotomy is usually performed for patients with congenital ossicular anomaly or fixation. However, otologic surgeons have often encountered difficulty due to the complexity of stapes surgery. Moreover, congenital stapes fixation with anomalous facial nerve and oval window absence is an uncommon and dangerous condition. In such cases, vestibulotomy can be a surgical option to prevent facial nerve damage and improve hearing. The etiology can be explained by the embryological development of the middle ear structures. To prevent facial nerve damage and maximize the efficacy of surgery, the surgeon should have knowledge about this disease and take a computed tomography for double check before stapes surgery. We describe a case of congenital stapes fixation with aberrant facial nerve courses, a 15-year-old female who was treated with vestibulotomy and piston wire insertion.
Adolescent ; Ear, Middle ; Facial Nerve* ; Female ; Hearing ; Hearing Loss, Conductive ; Humans ; Oval Window, Ear ; Stapes Surgery ; Stapes* ; Surgeons