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Molinari G, Fernandez IJ, Melchiorri C, Reale M, Bonali M, Presutti L, Lotto C, Lucidi D. “Hot” vs “Cold” endoscopic stapes surgery: a matched case–control study. Eur Arch Otorhinolaryngol 2022; 280:2257-2263. [PMID: 36380092 PMCID: PMC10066065 DOI: 10.1007/s00405-022-07739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
To compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO2 fiber laser or microdrill.
Methods
A case–control study was performed. All consecutive cases of CO2 fiber laser ESS operated at a single center during the period 2017–2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air–bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared.
Results
46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups.
Conclusion
This study is the first to compare hearing results and complications between CO2 fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.
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Taste impairment after endoscopic stapes surgery: Do anatomic variability of chorda tympani and surgical technique matter? : Post-operative dysgeusia after EStS. Eur Arch Otorhinolaryngol 2021; 279:2269-2277. [PMID: 34236486 DOI: 10.1007/s00405-021-06908-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate how the anatomical configuration of the oval window region (OWR) influences the management of the chorda tympani (ChT) and the curetting of adjacent bony structures, in a setting of patients undergoing endoscopic stapes surgery (EStS); to assess the incidence of early and late post-operative dysgeusia and to identify anatomical and surgical factors influencing taste function after EStS. METHODS Surgical video recordings of 48 patients undergoing EStS for otosclerosis between January 2019 and July 2020 were retrospectively revised, to classify the anatomical variability of selected middle ear structures and the management strategies for the ChT. Clinical records of included patients were reviewed for subjective early and late post-operative taste impairment using a 5-point Likert-scale. RESULTS The most common configuration of the OWR was type III. The extension of the bony curettage resulted inversely proportional to the exposure of the OWR. The long-term rate of preserved post-operative taste function was 85%. Displacement of the ChT was necessary in 43/48 cases (90%), mostly medially (36/48, 75%). CONCLUSION Bone curetting during EStS does not correlate with post-operative taste impairment. Despite 100% ChT preservation rate, dysgeusia may occur in a minority of patients, with no apparent relationship to anatomical variability or intraoperative management of the ChT. The use of CO2 laser could have a role in increasing the risk of post-operative dysgeusia after EStS.
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Lucidi D, Paludetti G, Settimi S, De Corso E, Picciotti PM, Sergi B. How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up. Audiol Neurootol 2020; 26:121-126. [PMID: 32882686 DOI: 10.1159/000509106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Stapes surgery is a safe procedure, with favourable hearing outcome. The objective of the study is to assess the long-term hearing results, addressing the bone conduction (BC) decay and the need for hearing aids in otosclerosis patients. METHODS We enrolled patients who underwent stapes surgery by means of stapedectomy or stapedotomy between 1991 and 2001. All enrolled patients underwent pure-tone audiometry (PTA) between September 2017 and June 2018. A set of questions was administered to record the prevalence of subjective symptoms and the need for hearing aids. RESULTS Seventy patients were enrolled for a long-term evaluation; 37 patients underwent bilateral surgery; therefore, 107 ears were included in the analysis. The average follow-up period was 22 years. No statistically significant difference was found between early and late post-operative air conduction (AC) PTA (41 vs. 49 dB; p > 0.05) nor between early and late post-operative BC-PTA (29 vs. 37 dB; p > 0.05). A significant difference was observed for AC at 8 kHz (65 vs. 78 dB; p < 0.05) and BC at 2 and 4 kHz (28 vs. 40 dB and 45 vs. 58 dB, respectively; p < 0.05). CONCLUSIONS This is, to our knowledge, the longest mean follow-up time in the literature. A mild decrease in both AC and BC threshold can be expected and the sensorineural decay is more pronounced on the high frequencies. The subjective hearing symptoms and overall sound perception are satisfactory.
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Affiliation(s)
- Daniela Lucidi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Stefano Settimi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Eugenio De Corso
- Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Pasqualina Maria Picciotti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | - Bruno Sergi
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy.,Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
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Lucidi D, Molinari G, Reale M, Alicandri-Ciufelli M, Presutti L. Functional Results and Learning Curve of Endoscopic Stapes Surgery: A 10-Year Experience. Laryngoscope 2020; 131:885-891. [PMID: 33124036 DOI: 10.1002/lary.28943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess hearing outcomes and complications of endoscopic stapes surgery by a single surgeon in a 10-year period, to compare these data with conventional microscopic procedures by the same operator, and to describe the learning curve of endoscopic stapedotomy. STUDY DESIGN Retrospective study. METHODS This is a retrospective study on patients who underwent endoscopic stapes surgery performed by the same senior surgeon, experienced both in microscopic and endoscopic techniques, between January 2009 and December 2018. Audiological data were compared, and intraoperative and postoperative complications were collected. The surgeon's last 30 cases of microscopic stapedotomy were enrolled as the control group. The results of the first 100 endoscopic stapes surgeries were analyzed separately to create a cumulative sum (CUSUM) control chart for learning curve assessment. RESULTS One hundred seventy-eight endoscopic and 30 microscopic stapes surgeries were included. In the endoscopic group, the mean postoperative air-bone gap was 8.2 dB. No significant differences between the endoscopic and microscopic preoperative and postoperative values were reported. A total of eight complications (4.5%) were observed in the endoscopic cohort, although in the control group, no complication occurred. The mean surgical time was 51.9 minutes in the endoscopic group versus 48.2 minutes in the microscopic group (P > .05). No association between stapedotomy success and the increasing number of procedures was found. CONCLUSIONS Our article demonstrates that functional results from endoscopic stapes surgery are similar to those from microscopic stapes surgery in terms of both safety and efficacy. After gaining endoscopic experience, the surgical duration of stapes surgery will be adequate starting from the first cases. LEVEL OF EVIDENCE 4 Laryngoscope, 131:885-891, 2021.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Marella Reale
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | | | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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Preferences in stapes surgery among American otological society otologists. World J Otorhinolaryngol Head Neck Surg 2020; 6:59-65. [PMID: 32426705 PMCID: PMC7221209 DOI: 10.1016/j.wjorl.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/18/2019] [Accepted: 12/29/2019] [Indexed: 11/21/2022] Open
Abstract
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.
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Quaranta N, Piccininni K, Romanello M, Lucidi D, Sergi B. The impact of intra-operative factors in otosclerosis outcomes: retrospective study in a tertiary centre. ACTA ACUST UNITED AC 2019; 39:197-204. [PMID: 31131839 PMCID: PMC6536026 DOI: 10.14639/0392-100x-2004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/23/2018] [Indexed: 11/23/2022]
Abstract
The aim of the study was to assess results from a large cohort of patients undergoing otosclerosis surgery with respect to the impact of intra-operative variables on post-operative hearing function and complications. We enrolled 384 patients affected by otosclerosis who were subjected to stapes surgery between 2004 and 2013 at a single institution. Surgery was performed in all cases under local anaesthesia, using a manual perforator and/or microdrill. Teflon-piston prosthesis was used in all patients. Audiological data obtained preoperatively and at last follow-up examination (minimum 12 months) were compared. Statistical analysis was performed using the multiple regression model. Peripheral rim otosclerosis and diffuse otosclerosis were associated with better functional results compared to the obliterative pattern (p < 0.05). Mean post-operative Air-Bone Gap was significantly higher in the 0.4 mm, compared to 0.6 mm piston group at 0.5 kHz (p < 0.001) and 1 kHz (p < 0.02); in the stapedotomy group a statistically significant difference was found between 0.4 and 0.6 mm piston groups, in favour of the latter (p < 0.05). No differences were encountered in terms of average hearing threshold and complications. Intra-operative variables cannot be fully predictable and our data could help in stratification of the results and as a landmark for the surgeon’s decisions.
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Affiliation(s)
- N Quaranta
- UOC Otorinolaringoiatria Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy
| | - K Piccininni
- UOC Otorinolaringoiatria Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy
| | - M Romanello
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Lucidi
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Sergi
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
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Bernardeschi D, Seta D, Canu G, Russo FY, Ferrary E, Lahlou G, Sterkers O. Does the diameter of the stapes prosthesis really matter? A prospective clinical study. Laryngoscope 2017; 128:1922-1926. [DOI: 10.1002/lary.27021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Daniele Bernardeschi
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Daniele Seta
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Giuseppina Canu
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Francesca Yoshie Russo
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Evelyne Ferrary
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Ghizlene Lahlou
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
| | - Olivier Sterkers
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull base surgery, Public Assistance‐Paris HospitalPitié‐Salpêtrière Group HospitalParis France
- Minimally Invasive Surgical Robotic Rehabilitation of Hearing, French Institute of Health and Medical ResearchMixed Unit of Research‐S 1159Paris France
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Canu G, Lauretani F, Russo FY, Ferrary E, Lamas G, Sterkers O, De Seta D, Bernardeschi D. Early functional results using the nitibond prosthesis in stapes surgery. Acta Otolaryngol 2017; 137:259-264. [PMID: 27809651 DOI: 10.1080/00016489.2016.1247499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION The NiTiBOND® prosthesis allows early results to be obtained similar to those with a manually crimped prosthesis fitted by experienced surgeons, thus reducing the learning curve in this critical step of the procedure. OBJECTIVE To analyze the 1-month results using the nitinol NiTiBOND® prosthesis in primary otosclerosis surgery and to compare the results with those obtained with fully fluoroplastic or fully titanium pistons. MATERIALS AND METHODS Fifty consecutive cases operated on with the NiTiBOND® prosthesis (nitinol group) were compared with 50 cases operated on with a fully fluoroplastic piston (fluoroplastic group), and with 131 cases operated on with a fully titanium piston (first titanium group), and also with 50 cases operated on with the same titanium piston just before using the NiTiBOND® piston (last titanium group). Pure-tone and speech audiometry was performed 1 month after surgery for the nitinol group. Comparison was made between the early hearing results of the four groups. RESULTS The mean air-bone gap closure for the nitinol group was 16 ± 1.0 dB (mean ± SEM, n = 50); an air-bone gap of <15 dB and <10 dB was obtained in 100% and 84% of cases, respectively. These hearing results were similar to the last titanium group and significantly better than those observed in the fluoroplastic and first titanium groups.
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