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Silva VAR, Pauna HF, Lavinsky J, Guimarães GC, Abrahão NM, Massuda ET, Vianna MF, Ikino CMY, Santos VM, Polanski JF, Silva MNLD, Sampaio ALL, Zanini RVR, Lourençone LFM, Denaro MMDC, Calil DB, Chone CT, Castilho AM. Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101303. [PMID: 37647735 PMCID: PMC10474207 DOI: 10.1016/j.bjorl.2023.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Guilherme Corrêa Guimarães
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Nicolau Moreira Abrahão
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericordia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Departamento de Cirurgia e Hospital Universitário, Florianópolis, SC, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackensie do Paraná, Curitiba, PR, Brazil
| | | | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | | | - Luiz Fernando Manzoni Lourençone
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil
| | | | - Daniela Bortoloti Calil
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Cohen-Vaizer M, Dreyfuss M, Na'ara S, Shinnawi S, Laske R. The Impact of Surgical Expertise on the Cost-Effectiveness of Stapes Surgery. Audiol Neurootol 2023; 28:436-445. [PMID: 37343529 DOI: 10.1159/000530783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Otosclerosis is the primary cause of conductive hearing loss with normal otoscopy. As the condition worsens, certain patients may develop a sensorineural component. Patients with successful surgeries may still need hearing aids, which creates a dilemma for health professionals as there are insufficient data to make informed decisions. This study investigated the influence of the surgeon's proficiency level, individual patient factors (e.g., age at the time of intervention and survival rates), and surgery costs on the cost-effectiveness of stapes surgery. METHODS We performed a cost-effectiveness analysis using an adapted Markov model incorporating annual all-cause mortalities. In addition, we introduced sensitivity analyses to address the effects of surgical expertise on adults with bilateral conductive hearing loss due to otosclerosis. A model was developed based on a decision tree with treatment options and complication scenarios for otosclerosis patients undergoing stapes surgery or receiving hearing aids. Annual all-cause mortality was considered. A sensitivity analysis was performed assigned to different training levels ("experts" and "less experienced") to simulate the effects of surgical experience on the cost-effectiveness of surgical outcomes. Successful surgery was defined as closing of the air-bone gap to 10 dB or less. Based on published data, "experts" were simulated with a 93.7% success rate, and "less experienced" were manufactured with a 68.9% success rate. RESULTS Stapes surgery provides improved quality of life (QoL) compared to hearing aids with lower cumulative costs up to 87 years of age in the case of "expert" surgeons and up to 78 years of age, when performed by "less experienced" surgeons. CONCLUSIONS Primary stapes surgery is highly cost-effective and delivers improved QoL compared to hearing aids with lower cumulative costs. Additionally, undergoing stapes surgical training remains highly cost-effective.
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Affiliation(s)
- Mauricio Cohen-Vaizer
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Michael Dreyfuss
- Department of Industrial Engineering and Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Shoorok Na'ara
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
- Department of Otolaryngology, Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA
| | - Shadi Shinnawi
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Roman Laske
- Department of Otolaryngology, HNO Wiedikon, Zurich, Switzerland
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Are there differences in revision stapes surgery outcomes between university and county clinics? A study from the quality register for otosclerosis surgery in Sweden. Eur Arch Otorhinolaryngol 2022; 280:2247-2255. [PMID: 36367582 PMCID: PMC10066141 DOI: 10.1007/s00405-022-07737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Purpose
The aim of the study was to investigate hearing outcomes in stapes revision surgery with regard to the type of clinic (university clinic or county clinic). Furthermore, the aim was to investigate the risk of complications with a focus on tinnitus, hearing deterioration, and taste disturbance 1 year after surgery.
Methods
The study is based on data from the Swedish Quality Register for Otosclerosis Surgery (SQOS). Two study protocols were completed by the surgeon, and a questionnaire was distributed to the patients 1 year after surgery. A total of 156 revisions were available for analysis with both preoperative and postoperative audiometry data.
Results
Seventy-five percent of the patients reported better to much better hearing 1 year after revision surgery. An air bone gap ≤ 20 dB postoperatively was seen in 77% of the patients. Four percent had hearing deterioration ≥ 20 dB PTA4 AC. Eleven percent had worsened or newly developed tinnitus, 5% had taste disturbance, and 3% had dizziness 1 year after surgery. Preoperative and postoperative hearing did not differ between patients operated on in university vs. county clinics.
Conclusions
Revision surgery in otosclerosis is a challenge for otologists, but no differences in hearing outcomes between university and county clinics were found in this nationwide study. The risk of hearing deterioration and deafness is higher than in primary stapes surgery, and revision surgery should be recommended primarily in cases with a large air–bone gap and moderate to severe preoperative hearing loss.
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Revision Stapes Surgery: A Novel Technique of Overcoming Erosion of the Long Process of Incus Using Hydroxylapatite Cement and Shape Memory Piston. Otol Neurotol 2020; 40:301-304. [PMID: 30741892 DOI: 10.1097/mao.0000000000002150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stapes surgery is performed to treat hearing loss in patients with otosclerosis. Erosion of the long process of incus can occur postoperatively and requires demanding revision surgery to further improve the hearing. The authors describe a novel method of performing revision stapes surgery where there is erosion of the long process of incus. METHODS A retrospective case series analysis of a database of revision stapes operations performed by one surgeon between July 2013 and December 2017 at a tertiary center was carried out. 26 cases were identified where there was significant erosion of long process of incus. The ossicular chain in these cases was reconstructed using a novel technique of using cement to fix the piston prosthesis to the incus remnant. The full technique is described herein. The pre- and postoperative audiometric data were analyzed. RESULTS Mean preoperative air bone gap (ABG) was 29.3 dB and mean postoperative ABG was 9.9 dB. Of the 22 patients with recorded postoperative masked bone conduction thresholds, 16 had ABG closure to < 10 dB (72.7%). CONCLUSION We have shown highly favorable outcomes using this novel technique in addressing erosion of the long process of incus in revision cases for patients with otosclerosis.
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Otosclerosis revision surgery in Sweden: hearing outcome, predictive factors and complications. Eur Arch Otorhinolaryngol 2019; 277:19-29. [DOI: 10.1007/s00405-019-05652-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
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Blijleven EE, Wegner I, Tange RA, Thomeer HGXM. Revision Stapes Surgery in a Tertiary Referral Center: Surgical and Audiometric Outcomes. Ann Otol Rhinol Laryngol 2019; 128:997-1005. [PMID: 31161780 PMCID: PMC6791027 DOI: 10.1177/0003489419853304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions. Methods: A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively. Results: In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, –2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another. Conclusions: Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.
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Affiliation(s)
- Esther E Blijleven
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rinze A Tange
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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Abstract
AbstractObjectiveThis paper highlights the importance of reporting air–bone gap closure in stapes surgery according to the American Academy of Otolaryngology – Head and Neck Surgery guidelines and reviews compliance in recent years.MethodsA retrospective case series was conducted and the outcomes were reviewed. Closure of the air–bone gap was calculated in 204 adult patients using the aforementioned guidelines. Results were recalculated ignoring the Carhart phenomenon to determine any significant difference. Adherence to guidelines was also reported as a secondary outcome.ResultsIgnoring the Carhart phenomenon resulted in 75 per cent over-reporting of successful air–bone gap closure (p< 0.001). Over-reporting occurred in 5.9 per cent of papers, and in 11.8 per cent it was difficult to determine how the results were reached.ConclusionDespite the existence of clear guidelines, stapes surgery outcomes are still being over-reported as successful. This can lead to incorrect information being provided to patients during the consent process and makes comparative studies difficult.
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Preliminary Outcomes Report for CO2 Laser Assisted Electric-Acoustic Cochlear Implantation. Otol Neurotol 2018; 39:582-590. [PMID: 29649047 DOI: 10.1097/mao.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report on the safety/efficacy of a novel, carbon dioxide (CO2) laser-assisted protocol for hearing-preservation cochlear implantation (HPCI) and electric-acoustic stimulation (EAS). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Adult patients meeting established criteria for HPCI and EAS. INTERVENTION Therapeutic/rehabilitative. A standardized protocol used CO2 laser to achieve meticulous hemostasis and perform cochleostomy was evaluated. MAIN OUTCOME MEASURES Audiometric assessments included low-tone pure tone average (LtPTA), consonant-nucleus-consonant (CNC), and AzBio scores. Primary outcomes were low-tone hearing-preservation (LtHP) and EAS usage rates. Secondary outcomes included change in LtPTA, outcomes durability, and the rate/onset/presentation of delayed hearing loss (DHL). Subset analyses stratified data by presenting LtPTA and surgeon experience. RESULTS Forty-seven patients and 52 ears were included. Mean follow-up was 20.7 ± 12.6 months. When adjusted for preoperative LtPTA less than 60 dB, the LtHP rate was 77%. This was significantly better than for patients with LtPTA more than 60 dB (24%; p < 0.0001). Outcomes were highly durable. EAS usage was excellent in those with LtPTA less than 60 dB (100%). Nine patients developed DHL. Three additional patients (25%) were successfully salvaged via steroids. Both CNC and AzBio scores improved significantly (p < 0.0001) at definitive testing. Speech-hearing scores did not differ significantly between patients using/not using EAS. The complication rate was 3.8%; none were caused by the laser. Surgeon experience was associated with significantly better outcomes. CONCLUSION Use of a CO2 laser-assisted HPCI protocol was safe and effective. Outcomes were consistent with contemporary literature reporting. Patient selection and surgeon experience both significantly impacted outcomes.
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Wegner I, Vincent R, Derks LSM, Rauh SP, Heymans MW, Stegeman I, Grolman W. An internally validated prognostic model for success in revision stapes surgery for otosclerosis. Laryngoscope 2018. [DOI: 10.1002/lary.27132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Laura S. M. Derks
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Simone P. Rauh
- Department of Epidemiology and Biostatistics; VU University Medical Centre, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics; VU University Medical Centre, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
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CO2 laser stapedotomy safety: influence of laser energy and time on bone-conduction hearing levels. Eur Arch Otorhinolaryngol 2017; 274:4131-4139. [DOI: 10.1007/s00405-017-4769-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
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Wegner I, Shahnaz N, Grolman W, Bance ML. Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study. Int J Audiol 2016; 56:1-7. [PMID: 27534272 DOI: 10.1080/14992027.2016.1214759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy. DESIGN WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis. STUDY SAMPLE Eight fresh-frozen temporal bones were harvested from human cadaveric donors. RESULTS At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value <0.01). The crimping conditions did not differ from one another (p = 0.555). CONCLUSION WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.
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Affiliation(s)
- Inge Wegner
- a Department of Otorhinolaryngology - Head and Neck Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.,b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands.,c Division of Otolaryngology, Department of Surgery , Dalhousie University , Halifax , NS , Canada , and
| | - Navid Shahnaz
- d School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Wilko Grolman
- a Department of Otorhinolaryngology - Head and Neck Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.,b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Manohar L Bance
- c Division of Otolaryngology, Department of Surgery , Dalhousie University , Halifax , NS , Canada , and
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Sergi B, Lucidi D, De Corso E, Paludetti G. Long-term follow-up after "one-shot" CO 2 laser stapedotomy: is the functional outcome stable during the years? Eur Arch Otorhinolaryngol 2016; 273:3623-3629. [PMID: 27007130 DOI: 10.1007/s00405-016-3976-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Abstract
The use of "one-shot" CO2 laser technique for a primary small-fenestra stapedotomy is well established, but few papers report the long-term functional results. We retrospectively reviewed medical records of 198 patients, treated for otosclerosis from January 2008 to December 2011, at the Department of Head and Neck Surgery, Catholic University of Rome. Statistical comparison between audiological thresholds obtained 24 h preoperatively, at early (4 weeks) and late postoperative examinations (mean time 45 months), was performed. Comparison of preoperative vs both early and late postoperative ACPTA showed a statistically significant difference (respectively 55 vs 33 and 31 dB; p < 0.001). No statistical difference was observed between preoperative, early and late postoperative BCPTA (respectively 23 vs 23 and 22 dB; p > 0.05). Both early and late postoperative ABG improved significantly compared to the preoperative one (respectively 10 and 9 vs 32 dB; p < 0.001). No statistical difference was found in comparison of early vs late postoperative ACPTA (respectively 33 vs 31 dB; p > 0.05), early vs late postoperative ABG (respectively 10 vs 9 dB; p > 0.05) and early vs late ABG gain (respectively 22 vs 23 dB; p > 0.05). No subjects developed postoperative complications requiring revision surgery or late deterioration of hearing threshold. The analysis of our data suggests that "one-shot" CO2 laser stapedotomy is an effective and safe procedure: it allows a rapid stapedotomy without damages for the inner ear and optimal functional results that remain stable during the years.
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Affiliation(s)
- Bruno Sergi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy.
| | - Daniela Lucidi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
| | - Eugenio De Corso
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
| | - Gaetano Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
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