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Barati B, Shahzamani A, Tabrizi AG, Asadi M. Post-stapedotomy dizziness after applying topical steroid on footplate: A randomized controlled trial. Laryngoscope Investig Otolaryngol 2024; 9:e1257. [PMID: 38736941 PMCID: PMC11081413 DOI: 10.1002/lio2.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/18/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Background Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative dizziness has been associated with stapedotomy. In 1981, intratympanic dexamethasone was utilized to manage inner ear disorders like tinnitus and acute sensorineural hearing loss. However, there is much uncertainty regarding the effect and safety of topical steroid therapy in the middle ear during stapedotomy. In the present study, we assessed the effect of topical steroid therapy during stapedotomy on postoperative dizziness. Methods Otosclerosis patients eligible for stapedotomy were randomly divided into two groups based on dexamethasone administration or placebo. Audiometric and tympanometry results were observed and recorded for the involved frequencies. The Dizziness Handicap Inventory was used to quantify patient perceptions of dizziness and balance issues. Audiometry and dizziness assessments were repeated at discharge and 4 months after the operation. Results The study comprised 72 otosclerosis patients undergoing stapedotomy. At discharge, the intervention group showed a significant reduction in the incidence of dizziness compared to the placebo group. However, in the 4-month follow-up after the operation, both groups experienced a decrease in dizziness incidence, with no significant difference between them. There was also no significant difference in audiometric levels between the two groups. Interestingly, the intervention group had a significantly lower need for systemic anti-dizziness drugs after surgery compared to the control group. Conclusion Topical dexamethasone during stapedotomy effectively minimizes dizziness at discharge and reduces the need for postoperative anti-dizziness medication. Level of evidence 2.
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Affiliation(s)
- Behrouz Barati
- Taleghani Hospital Clinical Research Development UnitShahid Beheshti University of Medical ScienceTehranIran
| | - Arvin Shahzamani
- Taleghani Hospital Clinical Research Development UnitShahid Beheshti University of Medical ScienceTehranIran
| | - Ali Goljanian Tabrizi
- Taleghani Hospital Clinical Research Development UnitShahid Beheshti University of Medical ScienceTehranIran
| | - Mahboobe Asadi
- Taleghani Hospital Clinical Research Development UnitShahid Beheshti University of Medical ScienceTehranIran
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2
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Blijleven EE, Jellema M, Stokroos RJ, Wegner I, Thomeer HGXM. The effect of piston diameter in primary stapes surgery on surgical success. Eur Arch Otorhinolaryngol 2024; 281:2931-2939. [PMID: 38273045 PMCID: PMC11065942 DOI: 10.1007/s00405-023-08407-w] [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: 08/07/2023] [Accepted: 12/09/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications. METHODS A retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2 and 3 kHz. RESULTS In total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air-bone gap (median = 7.5 and 9.4 dB, respectively), gain in air-bone gap (median = 20.0 and 18.1 dB, respectively), air-bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group. CONCLUSION The use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it.
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Affiliation(s)
- Esther E Blijleven
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Maaike Jellema
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Eberhard KE, Merchant GR, Nakajima HH, Neely ST. Toward Automating Diagnosis of Middle- and Inner-ear Mechanical Pathologies With a Wideband Absorbance Regression Model. Ear Hear 2024:00003446-990000000-00283. [PMID: 38797886 DOI: 10.1097/aud.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES During an initial diagnostic assessment of an ear with normal otoscopic exam, it can be difficult to determine the specific pathology if there is a mechanical lesion. The audiogram can inform of a conductive hearing loss but not the underlying cause. For example, audiograms can be similar between the inner-ear condition superior canal dehiscence (SCD) and the middle-ear lesion stapes fixation (SF), despite differences in pathologies and sites of lesion. To gain mechanical information, wideband tympanometry (WBT) can be easily performed noninvasively. Absorbance , the most common WBT metric, is related to the absorbed sound energy and can provide information about specific mechanical pathologies. However, absorbance measurements are challenging to analyze and interpret. This study develops a prototype classification method to automate diagnostic estimates. Three predictive models are considered: one to identify ears with SCD versus SF, another to identify SCD versus normal, and finally, a three-way classification model to differentiate among SCD, SF, and normal ears. DESIGN Absorbance was measured in ears with SCD and SF as well as normal ears at both tympanometric peak pressure (TPP) and 0 daPa. Characteristic impedance was estimated by two methods: the conventional method (based on a constant ear-canal area) and the surge method, which estimates ear-canal area acoustically.Classification models using multivariate logistic regression predicted the probability of each condition. To quantify expected performance, the condition with the highest probability was selected as the likely diagnosis. Model features included: absorbance-only, air-bone gap (ABG)-only, and absorbance+ABG. Absorbance was transformed into principal components of absorbance to reduce the dimensionality of the data and avoid collinearity. To minimize overfitting, regularization, controlled by a parameter lambda, was introduced into the regression. Average ABG across multiple frequencies was a single feature.Model performance was optimized by adjusting the number of principal components, the magnitude of lambda, and the frequencies included in the ABG average. Finally, model performances using absorbance at TPP versus 0 daPa, and using the surge method versus constant ear-canal area were compared. To estimate model performance on a population unknown by the model, the regression model was repeatedly trained on 70% of the data and validated on the remaining 30%. Cross-validation with randomized training/validation splits was repeated 1000 times. RESULTS The model differentiating between SCD and SF based on absorbance-only feature resulted in sensitivities of 77% for SCD and 82% for SF. Combining absorbance+ABG improved sensitivities to 96% and 97%. Differentiating between SCD and normal using absorbance-only provided SCD sensitivity of 40%, which improved to 89% by absorbance+ABG. A three-way model using absorbance-only correctly classified 31% of SCD, 20% of SF and 81% of normal ears. Absorbance+ABG improved sensitivities to 82% for SCD, 97% for SF and 98% for normal. In general, classification performance was better using absorbance at TPP than at 0 daPa. CONCLUSION The combination of wideband absorbance and ABG as features for a multivariate logistic regression model can provide good diagnostic estimates for mechanical ear pathologies at initial assessment. Such diagnostic automation can enable faster workup and increase efficiency of resources.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Copenhagen Hearing and Balance Centre, Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Rebol J, Povalej Bržan P. Audiometric and Vestibular Function after Classic and Reverse Stapedotomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:803. [PMID: 38792986 PMCID: PMC11123093 DOI: 10.3390/medicina60050803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the surgical steps in stapedotomy impacts vestibular function and hearing improvement. Materials and Methods: A cohort of 123 patients underwent either classic or reverse stapedotomy procedures utilizing a fiber-optic argon laser. Audiological assessments, following the guidelines of the Committee on Hearing and Equilibrium, were conducted, including pure tone average, air-bone (AB) gap, overclosure, and AB gap closure. Vestibular evaluation involved pre- and postoperative comparison of rotatory test parameters, including frequency, amplitude, and slow phase velocity of nystagmus. Results: The study demonstrated an overall median overclosure of 3.3 (3.3, 5.0) dB and a mean AB gap closure of 20.3 ± 8.8 dB. Postoperative median AB gap was 7.5 (7.5, 11.3) dB in the reverse stapedotomy group and 10.0 (10.0, 12.5) dB in the classic stapedotomy group. While overclosure and AB gap closure were marginally superior in the reverse stapedotomy group, these differences did not reach statistical significance. No significant disparities were observed in the frequency, slow phase velocity, or amplitude of nystagmus in the rotational test. Conclusions: Although not always possible, reverse stapedotomy proved to be a safe surgical technique regarding postoperative outcomes. Its adoption may mitigate risks associated with floating footplate, sensorineural hearing loss, and incus luxation/subluxation, while facilitating the learning curve for less experienced ear surgeons.
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Affiliation(s)
- Janez Rebol
- Department of Otorhinolaryngology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia;
| | - Petra Povalej Bržan
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia;
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska Cesta 46, 2000 Maribor, Slovenia
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Wang Z, Song J, Lin K, Hong W, Mao S, Wu X, Zhang J. Automated detection of otosclerosis with interpretable deep learning using temporal bone computed tomography images. Heliyon 2024; 10:e29670. [PMID: 38655358 PMCID: PMC11036044 DOI: 10.1016/j.heliyon.2024.e29670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study aimed to develop an automated detection schema for otosclerosis with interpretable deep learning using temporal bone computed tomography images. Methods With approval from the institutional review board, we retrospectively analyzed high-resolution computed tomography scans of the temporal bone of 182 participants with otosclerosis (67 male subjects and 115 female subjects; average age, 36.42 years) and 157 participants without otosclerosis (52 male subjects and 102 female subjects; average age, 30.61 years) using deep learning. Transfer learning with the pretrained VGG19, Mask RCNN, and EfficientNet models was used. In addition, 3 clinical experts compared the system's performance by reading the same computed tomography images for a subset of 35 unseen subjects. An area under the receiver operating characteristic curve and a saliency map were used to further evaluate the diagnostic performance. Results In prospective unseen test data, the diagnostic performance of the automatically interpretable otosclerosis detection system at the optimal threshold was 0.97 and 0.98 for sensitivity and specificity, respectively. In comparison with the clinical acumen of otolaryngologists at P < 0.05, the proposed system was not significantly different. Moreover, the area under the receiver operating characteristic curve for the proposed system was 0.99, indicating satisfactory diagnostic accuracy. Conclusion Our research develops and evaluates a deep learning system that detects otosclerosis at a level comparable with clinical otolaryngologists. Our system is an effective schema for the differential diagnosis of otosclerosis in computed tomography examinations.
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Affiliation(s)
- Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Jian Song
- Department of Otorhinolaryngology, Xiangya Hospital Central South University, Changsha, Hunan, China
- Province Key Laboratory of Otolaryngology Critical Diseases, Changsha, Hunan, China
| | - Kaibin Lin
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Wei Hong
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Key Laboratory of Informalization Technology for Basic Education in Hunan Province, Changsha, 410205, China
| | - Shuang Mao
- Department of Otorhinolaryngology, Xiangya Hospital Central South University, Changsha, Hunan, China
- Province Key Laboratory of Otolaryngology Critical Diseases, Changsha, Hunan, China
| | - Xuewen Wu
- Department of Otorhinolaryngology, Xiangya Hospital Central South University, Changsha, Hunan, China
- Province Key Laboratory of Otolaryngology Critical Diseases, Changsha, Hunan, China
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University. The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, 518020, Guangdong, China
- Department of Geriatrics, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University. The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
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Wiatr M, Bartoszewicz R, Niemczyk K, Wiatr A. Effect of stapes demineralisation on the development of cochlear otosclerosis. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:120-127. [PMID: 38420840 DOI: 10.14639/0392-100x-n2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/16/2023] [Indexed: 03/02/2024]
Abstract
Objective The involvement of the inner ear in otosclerosis may lead to the development of cochlear otosclerosis. The aim of this study was to analyse changes in the chemical composition and microstructure of the stapes in the course of otosclerosis compared to healthy stapes. Materials and methods This analysis included 31 patients with otosclerosis and 9 patients without otosclerosis. Microanalytical and diffraction techniques were used to assess the elemental distribution and orientation topography of the stapes. Results The concentration of Ca2+ in the study group was significantly lower in the area of the anterior crus of the stapes than in the posterior crus. A reduction in the Ca2+/P3+ ratio in the anterior crus was associated with deteriorated bone conduction and tinnitus. Degradation of the stapes microstructure in the area of otosclerotic lesions was observed with scanning electron microscopy. Conclusions Bone remodelling is most significant at the closest location to typical otosclerotic lesions with hydroxyapatite porosity and scale-like bone formation according to scanning electron microscopy. There is a relationship between the disturbance of calcium metabolism and the development of clinical symptoms of cochlear otosclerosis.
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Affiliation(s)
- Maciej Wiatr
- Department of Otolaryngology, Jagiellonian University Medical College, Kraków, Poland
| | - Robert Bartoszewicz
- Department of Otolaryngology, Head and Neck Surgery, Medical University, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Head and Neck Surgery, Medical University, Warsaw, Poland
| | - Agnieszka Wiatr
- Department of Otolaryngology, Jagiellonian University Medical College, Kraków, Poland
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Bouatay R, Benelhaj C, Saad J, Zrig A, Ferjaoui M, Elkorbi A, Kolsi N, Harrathi K, Koubaa J. Interest of computer tomography in the study of prognostic factors of otosclerosis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08585-1. [PMID: 38530462 DOI: 10.1007/s00405-024-08585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Otosclerosis is a primary osteodystrophy of the otic capsule that causes stapedo-vestibular ankylosis. Its diagnosis is suspected on the basis of clinical and audiometric elements, basically in the presence of conductive hearing loss with a normal eardrum. The CT-scan is an essential examination for the preoperative evaluation of otosclerosis. The aim of our study was to evaluate the use of CT-scanning in predicting the functional outcome of otosclerosis surgery by correlating postoperative audiometric results and preoperative CT findings. METHODS We conducted a retrospective study at the ENT Department in association with the Medical Imaging Department of our hospital, over a period of 8 years, from January 2014 to December 2022 and involving 90 patients (104 ears). RESULTS The average age of our patients was 40 years with extremes ranging from 22 to 61 years. We noted a sex ratio of 0.38. The preoperative CT-scan showed signs of otosclerosis in 87% of the cases and infra-radiological forms in 13% of the cases. Veillon stage II was the most frequent radiological stage encountered with a percentage of 48%. A good audiometric evolution, defined by a closure of postoperative Air Bone Gap (ABG ≤ 20 dB) and by an improvement of Bone Conduction (BC gain ≥ 0), was recorded in 86 cases (82.7%) for ABG and in 84 cases (80.8%) for BC gain. Scanographic predictive factors of poor postoperative outcome for ABG and BC gain were: advanced stages (Veillon stage III and IV), endosteal effraction, and round window involvement. According to multivariate analysis, only the extent of otosclerotic foci was directly and independently associated with the postoperative audiometric outcome. CONCLUSION The CT-scan is an essential examination in the preoperative evaluation of otosclerosis. It allows a positive diagnosis to be made and evaluate the extension of otosclerosis. Moreover, thanks to the analysis of the extent of the otosclerosis foci, mainly by the Veillon classification, the CT-scan allows to predict the postoperative audiometric prognosis.
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Affiliation(s)
- Rachida Bouatay
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia.
- University of Monastir, Monastir, Tunisia.
| | - Chirine Benelhaj
- Medical Imaging Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
| | - Jamel Saad
- Medical Imaging Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Ahmed Zrig
- Medical Imaging Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Mehdi Ferjaoui
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Amel Elkorbi
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Naourez Kolsi
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Khaled Harrathi
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Jamel Koubaa
- ENT Department, Fattouma Bourguiba Hospital of Monastir, Monastir, Tunisia
- University of Monastir, Monastir, Tunisia
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Gillet R, Eliezer M, Hossu G, Lombard C, Boubaker F, Blum A, Gondim Teixeira PA, Parietti-Winkler C. Measurement of stapes footplate thickness using ultra-high-resolution computed tomography: stapes axial plane correlates better with otosclerosis than lateral semicircular canal plane. Acta Otolaryngol 2024; 144:219-225. [PMID: 38662875 DOI: 10.1080/00016489.2024.2340083] [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: 03/02/2024] [Accepted: 03/28/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND, AIMS Stapes footplate thickness measurement using ultra-high-resolution CT has been described only in the lateral semicircular canal plane. The purpose of this study was to compare stapes footplate thickness between the lateral semicircular canal and stapes axial planes in patients with otosclerosis compared to controls. MATERIAL AND METHODS We performed a retrospective single-center study of patients undergoing high-resolution temporal bone CT. Two radiologists measured stapes footplate thickness in both the lateral semicircular canal and stapes axial planes. RESULTS Between February 2020 and October 2022, we collected 81 ears from 49 patients (75% of women; mean age 51.22 ± 16.6 years, 17 otosclerosis, and 64 controls). In the stapes axial plane, there was a significant anterior thickening in otosclerosis patients (Reader 1: 0.52 ± 0.12 [0.3-0.7] vs. 0.41 ± 0.08 [0.3-0.6], p = 0.001; Reader 2: 0.54 ± 0.06 [0.5-0.7] vs. 0.39 ± 0.08 [0.2-0.6], P < 0.001) compared to controls. These differences were not significant using the lateral semicircular canal plane. CONCLUSION The stapes footplate was thickened at its AC in otosclerosis patients using only the stapes axial plane. SIGNIFICANCE We propose to use the stapes axial plane instead of the lateral semicircular canal plane when analyzing the stapes.
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Affiliation(s)
- Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Michael Eliezer
- Department of Radiology, Lariboisière Hospital, Paris, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Charles Lombard
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
| | - Fatma Boubaker
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Parietti-Winkler
- ENT Surgery Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
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9
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Lenkeit CP, Fritz CG, Choi JS, Schutt CA, Hong RS, Babu SC, Bojrab DI. Quantifying the effect of shoulder size on operation duration: an analysis of stapes surgery outcomes. J Laryngol Otol 2024; 138:258-264. [PMID: 37203445 DOI: 10.1017/s0022215123000890] [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] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To investigate the effect of body mass index on hearing outcomes, operative time and complication rates following stapes surgery. METHOD This is a five-year retrospective review of 402 charts from a single tertiary otology referral centre from 2015 to 2020. RESULTS When the patient's shoulder was adjacent to the surgeon's dominant hand, the average operative time of 40 minutes increased to 70 minutes because of a significant positive association between higher body mass index and longer operative times (normal body mass index group (<25 kg/m2) r = 0.273, p = 0.032; overweight body mass index group (25-30 kg/m2) r = 0.265, p = 0.019). Operative times were not significantly longer upon comparison of low and high body mass index groups without stratification by laterality (54.9 ± 19.6 minutes vs 57.8 ± 19.2 minutes, p = 0.127). CONCLUSION There is a clinically significant relationship between body mass index and operating times. This may be due to access limitations imposed by shoulder size.
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Affiliation(s)
- Christopher P Lenkeit
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, McLaren Oakland, Pontiac, Michigan, USA
| | - Christian G Fritz
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Christopher A Schutt
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Seilesh C Babu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
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Parillo M, Bitonti MT, Vaccarino F, Zobel BB, Mallio CA. Temporal Bone High Resolution Computed Tomography Findings in a Case of Postpartum Otosclerosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1130-1133. [PMID: 38440651 PMCID: PMC10908701 DOI: 10.1007/s12070-023-04167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Maria Teresa Bitonti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128 Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128 Italy
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11
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Chen PH, Lin KN, Lin HY, Yu RB, Liu PY, Shih WT, Chen JW. Factors Associated With Hearing Outcomes After Stapedotomy in Taiwanese Patients With Clinical Otosclerosis. EAR, NOSE & THROAT JOURNAL 2024; 103:NP76-NP84. [PMID: 34409887 DOI: 10.1177/01455613211037645] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis. METHODS In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis. RESULTS Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds (P < .0001), bone conduction (BC) thresholds (P = .025), and air-bone gaps (ABGs; P < .0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r = .650, P < .001 and r = .745, P < .001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r = .893, P < .001 and r = .476, P = .014, respectively), and in postoperative and preoperative ABGs (r = .933, P < .001 and r = .626, P < .001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes. CONCLUSIONS We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate.
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Affiliation(s)
- Pei-Hsin Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Kai-Nan Lin
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Hsiu-Yin Lin
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Rui-Bin Yu
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
| | - Pi-Yun Liu
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
| | - Wan-Ting Shih
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City
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12
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Cırık AA, Yiğit YE, Tekin AM, Duymaz YK, Şahin Ş, Erkmen B, Topsakal V. Comprehensiveness of online sources for patient education on otosclerosis. Front Surg 2024; 11:1327793. [PMID: 38327547 PMCID: PMC10847337 DOI: 10.3389/fsurg.2024.1327793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose This study aimed to assess the readability indices of websites including educational materials on otosclerosis. Methods We performed a Google search on 19 April 2023 using the term "otosclerosis." The first 50 hits were collected and analyzed. The websites were categorized into two groups: websites for health professionals and general websites for patients. Readability indices were calculated using the website https://www.webfx.com/tools/read-able/. Results A total of 33 websites were eligible and analyzed (20 health professional-oriented and 13 patient-oriented websites). When patient-oriented websites and health professional-oriented websites were individually analyzed, mean Flesch Reading Ease scores were found to be 52.16 ± 14.34 and 46.62 ± 10.07, respectively. There was no significant difference between the two groups upon statistical analysis. Conclusion Current patient educational material available online related to otosclerosis is written beyond the recommended sixth-grade reading level. The quality of good websites is worthless to the patients if they cannot comprehend the text.
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Affiliation(s)
- Ahmet Adnan Cırık
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Yeşim Esen Yiğit
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Ahmet Mahmut Tekin
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels Health Campus, Brussels, Belgium
| | - Yaşar Kemal Duymaz
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | | | - Burak Erkmen
- Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Department of Otolaryngology, University of Health Sciences, İstanbul, Türkiye
| | - Vedat Topsakal
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels Health Campus, Brussels, Belgium
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13
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Drabkin M, Jean MM, Noy Y, Halperin D, Yogev Y, Wormser O, Proskorovski-Ohayon R, Dolgin V, Levaot N, Brumfeld V, Ovadia S, Kishner M, Kazenell U, Avraham KB, Shelef I, Birk OS. SMARCA4 mutation causes human otosclerosis and a similar phenotype in mice. J Med Genet 2024; 61:117-124. [PMID: 37399313 PMCID: PMC10756932 DOI: 10.1136/jmg-2023-109264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Otosclerosis is a common cause of adult-onset progressive hearing loss, affecting 0.3%-0.4% of the population. It results from dysregulation of bone homeostasis in the otic capsule, most commonly leading to fixation of the stapes bone, impairing sound conduction through the middle ear. Otosclerosis has a well-known genetic predisposition including familial cases with apparent autosomal dominant mode of inheritance. While linkage analysis and genome-wide association studies suggested an association with several genomic loci and with genes encoding structural proteins involved in bone formation or metabolism, the molecular genetic pathophysiology of human otosclerosis is yet mostly unknown. METHODS Whole-exome sequencing, linkage analysis, generation of CRISPR mutant mice, hearing tests and micro-CT. RESULTS Through genetic studies of kindred with seven individuals affected by apparent autosomal dominant otosclerosis, we identified a disease-causing variant in SMARCA4, encoding a key component of the PBAF chromatin remodelling complex. We generated CRISPR-Cas9 transgenic mice carrying the human mutation in the mouse SMARCA4 orthologue. Mutant Smarca4+/E1548K mice exhibited marked hearing impairment demonstrated through acoustic startle response and auditory brainstem response tests. Isolated ossicles of the auditory bullae of mutant mice exhibited a highly irregular structure of the incus bone, and their in situ micro-CT studies demonstrated the anomalous structure of the incus bone, causing disruption in the ossicular chain. CONCLUSION We demonstrate that otosclerosis can be caused by a variant in SMARCA4, with a similar phenotype of hearing impairment and abnormal bone formation in the auditory bullae in transgenic mice carrying the human mutation in the mouse SMARCA4 orthologue.
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Affiliation(s)
- Max Drabkin
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Matan M Jean
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yael Noy
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Halperin
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yuval Yogev
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ohad Wormser
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Regina Proskorovski-Ohayon
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Vadim Dolgin
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noam Levaot
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vlad Brumfeld
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel
| | - Shira Ovadia
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mor Kishner
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Udi Kazenell
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Karen B Avraham
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shelef
- Department of Radiology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ohad S Birk
- The Morris Kahn Laboratory of Human Genetics, Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Genetics Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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14
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Job K, Wiatr A, Wiatr M. Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis. EAR, NOSE & THROAT JOURNAL 2023; 102:709-714. [PMID: 34176331 DOI: 10.1177/01455613211023014] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis. METHODS The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed. RESULTS A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy. CONCLUSIONS A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air-bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.
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Affiliation(s)
- Katarzyna Job
- Department of Otolaryngology, Jagiellonian University Medical College in Kraków, Poland
| | - Agnieszka Wiatr
- Department of Otolaryngology, Jagiellonian University Medical College in Kraków, Poland
| | - Maciej Wiatr
- Department of Otolaryngology, Jagiellonian University Medical College in Kraków, Poland
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15
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Zambonini G, Ghiselli S, Di Trapani G, Salsi D, Cuda D. Cavitating Lesions around the Cochlea Can Affect Audiometric Threshold and Clinical Practice. Audiol Res 2023; 13:821-832. [PMID: 37887853 PMCID: PMC10604480 DOI: 10.3390/audiolres13050072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
There are several pathologies that can change the anatomy of the otic capsule and that can distort the bone density of the bony structures of the inner ear, but otosclerosis is one of the most frequent. Similar behavior has been shown in patients affected by osteogenesis imperfecta (OI), a genetic disorder due to a mutation in the genes coding for type I (pro) collagen. In particular, we note that otosclerosis and OI can lead to bone resorption creating pericochlear cavitations in contact with the internal auditory canal (IAC). In this regard, we have collected five cases presenting this characteristic; their audiological data and clinical history were analyzed. This feature can be defined as a potential cause of a third-window effect, because it causes an energy loss during the transmission of sound waves from the oval window (OW) away from the basilar membrane.
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Affiliation(s)
| | - Sara Ghiselli
- ENT Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; (G.Z.); (G.D.T.); (D.S.); (D.C.)
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16
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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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17
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Moneir W, Khafagy YW, Salem NN, Hemdan A. Endoscopic stapedotomy: classic versus reversal technique. Eur Arch Otorhinolaryngol 2023; 280:3653-3659. [PMID: 36797512 PMCID: PMC10313534 DOI: 10.1007/s00405-023-07880-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To compare hearing outcome and surgical complications between endoscopic classic and reversal stapedotomies. PATIENTS AND METHODS A prospective single blinded randomized clinical study carried out on 60 patients with otosclerosis who were randomized into two groups; each containing 30 patients. Patients in group 1 underwent endoscopic classic stapedotomy. Patients in group 2 underwent endoscopic reversal stapedotomy. Both groups were compared as regards hearing outcome and surgical complications. RESULTS The difference in the hearing outcome between the two groups was statistically non-significant. Post-operative closure of the air bone gap (ABG) within 10 dB was attained in 76.67% and 80% of patients in groups 1 and 2, respectively. The differences in the surgical complications between the two studied groups were statistically non-significant. CONCLUSION Endoscopic classic and reversal stapedotomies are comparable to each other as regards hearing outcome and surgical complications. The authors recommend further studies with relatively larger sample size.
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Affiliation(s)
- Waleed Moneir
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Yasser Wafeek Khafagy
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Nada Nagah Salem
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt
| | - Ahmed Hemdan
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Mansoura, Egypt.
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18
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Sharaf K, Müller J. [Revision surgery after stapedectomy]. HNO 2023; 71:535-546. [PMID: 37470870 DOI: 10.1007/s00106-023-01326-6] [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] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
Revision stapes surgery is considered to be significantly more demanding than primary stapes surgery, both in terms of the indication and the surgical approach. This article reviews common indications for revision after stapedectomy as well as the surgical approaches and intraoperative findings. A distinction is made between revision surgeries, which are usually carried out because of conductive hearing loss a long time after stapes surgery, and acute or subacute revisions that become necessary in the immediate postoperative course. With the shortening of postoperative observation times under inpatient conditions as a result of increasing economization and the associated shift of the immediate postoperative phase to the outpatient setting, the recognition of postoperative irregularities is also becoming increasingly important for otorhinolaryngologists in private practice, even if they do not perform these highly specialized interventions themselves.
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Affiliation(s)
- Kariem Sharaf
- Klinik und Poliklinik für Hals‑Nasen-Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Joachim Müller
- Klinik und Poliklinik für Hals‑Nasen-Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
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19
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Palma-Lara I, García Alonso-Themann P, Pérez-Durán J, Godínez-Aguilar R, Bonilla-Delgado J, Gómez-Archila D, Espinosa-García AM, Nolasco-Quiroga M, Victoria-Acosta G, López-Ornelas A, Serrano-Bello JC, Olguín-García MG, Palacios-Reyes C. Potential Role of Protein Kinase FAM20C on the Brain in Raine Syndrome, an In Silico Analysis. Int J Mol Sci 2023; 24:ijms24108904. [PMID: 37240249 DOI: 10.3390/ijms24108904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
FAM20C (family with sequence similarity 20, member C) is a serine/threonine-specific protein kinase that is ubiquitously expressed and mainly associated with biomineralization and phosphatemia regulation. It is mostly known due to pathogenic variants causing its deficiency, which results in Raine syndrome (RNS), a sclerosing bone dysplasia with hypophosphatemia. The phenotype is recognized by the skeletal features, which are related to hypophosphorylation of different FAM20C bone-target proteins. However, FAM20C has many targets, including brain proteins and the cerebrospinal fluid phosphoproteome. Individuals with RNS can have developmental delay, intellectual disability, seizures, and structural brain defects, but little is known about FAM20C brain-target-protein dysregulation or about a potential pathogenesis associated with neurologic features. In order to identify the potential FAM20C actions on the brain, an in silico analysis was conducted. Structural and functional defects reported in RNS were described; FAM20C targets and interactors were identified, including their brain expression. Gene ontology of molecular processes, function, and components was completed for these targets, as well as for potential involved signaling pathways and diseases. The BioGRID and Human Protein Atlas databases, the Gorilla tool, and the PANTHER and DisGeNET databases were used. Results show that genes with high expression in the brain are involved in cholesterol and lipoprotein processes, plus axo-dendritic transport and the neuron part. These results could highlight some proteins involved in the neurologic pathogenesis of RNS.
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Affiliation(s)
- Icela Palma-Lara
- Laboratorio de Morfología Celular y Molecular, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
| | | | - Javier Pérez-Durán
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México 11000, Mexico
| | | | - José Bonilla-Delgado
- Unidad de Investigación, Hospital Regional de Ixtapaluca, Ixtapaluca 56530, Mexico
- Departamento de Biotecnología, Escuela de Ingeniería y Ciencias, Instituto Tecnológico de Monterrey, Toluca de Lerdo 50110, Mexico
| | - Damián Gómez-Archila
- Departamento de Oncología Quirúrgica, Hospital de Gineco-Obstetricia 3, Centro Médico Nacional "La Raza", Ciudad de México 02990, Mexico
| | | | - Manuel Nolasco-Quiroga
- Coordinación de Enseñanza e Investigación, Clínica Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Huauchinango 73177, Mexico
| | | | - Adolfo López-Ornelas
- División de Investigación, Hospital Juárez de México, Ciudad de México 11340, Mexico
| | - Juan Carlos Serrano-Bello
- Departamento de Patología Clínica y Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | | | - Carmen Palacios-Reyes
- División de Investigación, Hospital Juárez de México, Ciudad de México 11340, Mexico
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Neveü S, Becker M, Guinand N, Mainta IC, Lenoir V. Increased Petrous Bone Uptake on 18 F-PSMA-1007 PET/CT Due to Otospongiosis. Clin Nucl Med 2023; 48:414-416. [PMID: 36881571 DOI: 10.1097/rlu.0000000000004611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT We report the case of a 74-year-old man who had undergone radical prostatectomy for prostatic cancer 6 months earlier. Elevated prostate-specific antigen during follow-up prompted 18 F-prostate-specific membrane antigen (PSMA) ligand PET/CT ( 18 F-PSMA-1007 PET/CT) to search for new manifestations of prostate cancer, revealing an increased focal uptake (SUV max , 5.9) in the left cochlear/pericochlear temporal bone and equivocal PSMA-RADS-3a external iliac nodes. Comparison with cone-beam CT and MRI showed that the focal temporal bone uptake corresponded to the typical morphological features of active otospongiosis (otosclerosis) in the context of a previously known long-standing otospongiosis.
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Affiliation(s)
- Sophie Neveü
- From the Division of Radiology, Diagnostic Department
| | | | - Nils Guinand
- Clinic of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences
| | - Ismini Charis Mainta
- Division of Nuclear Medicine, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Genome-wide screen of otosclerosis in population biobanks: 27 loci and shared associations with skeletal structure. Nat Commun 2023; 14:157. [PMID: 36653343 PMCID: PMC9849444 DOI: 10.1038/s41467-022-32936-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 08/24/2022] [Indexed: 01/19/2023] Open
Abstract
Otosclerosis is one of the most common causes of conductive hearing loss, affecting 0.3% of the population. It typically presents in adulthood and half of the patients have a positive family history. The pathophysiology of otosclerosis is poorly understood. A previous genome-wide association study (GWAS) identified a single association locus in an intronic region of RELN. Here, we report a meta-analysis of GWAS studies of otosclerosis in three population-based biobanks comprising 3504 cases and 861,198 controls. We identify 23 novel risk loci (p < 5 × 10-8) and report an association in RELN and three previously reported candidate gene or linkage regions (TGFB1, MEPE, and OTSC7). We demonstrate developmental stage-dependent immunostaining patterns of MEPE and RUNX2 in mouse otic capsules. In most association loci, the nearest protein-coding genes are implicated in bone remodelling, mineralization or severe skeletal disorders. We highlight multiple genes involved in transforming growth factor beta signalling for follow-up studies.
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Stenz NA, Hashmi S, Lehnick D, Treumann T, Linder T. [Role of computed tomography in the preoperative diagnosis of otosclerosis]. HNO 2023; 71:92-99. [PMID: 36326852 PMCID: PMC9895003 DOI: 10.1007/s00106-022-01241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Otosclerosis is an osteodystrophy of the otic capsule and presents with progressive conductive hearing loss. Imaging studies, especially computed tomography (CT) and cone-beam CT, have gained increased relevance in the diagnosis of otosclerosis. OBJECTIVE This study investigated whether there is a correlation between the extent of otosclerosis in high-resolution or cone-beam CT and hearing loss in pure-tone audiometry. MATERIALS AND METHODS Based on an existing classification of otosclerotic foci, a classification was established. Preoperative CT scans of patients undergoing stapedotomy between 2015 and 2019 were evaluated and classified by two independent otorhinolaryngologists. The preoperative pure-tone audiograms were analysed and compared to the results of CT. RESULTS A total of 168 CT studies (i.e., 168 ears) in 156 patients with intraoperatively confirmed otosclerosis were included in our study. A correlation between the extent of the otosclerotic focus or the calculated scores and hearing loss in pure-tone audiometry (air conduction, bone conduction and air-bone-gap) could not be proven. CONCLUSION Preoperative CT is not obligatory. However, preoperative imaging using CT or cone-beam CT can be helpful to confirm the diagnosis and exclude other middle or inner ear pathologies as well as in planning of the surgical procedure in the overall context of otoscopy and audiometry. A correlation with the degree of hearing impairment could not be demonstrated and remains unclear.
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Affiliation(s)
- Nadja Angela Stenz
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz.
| | - Salman Hashmi
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz
| | - Dirk Lehnick
- Gesundheitswissenschaften und Medizin, Universität Luzern, Luzern, Schweiz
| | - Thomas Treumann
- Klinik für Radiologie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Thomas Linder
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz
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Tuset M, Baptiste A, Cyna Gorse F, Sterkers O, Nguyen Y, Lahlou G, Ferrary E, Mosnier I. Facial nerve stimulation in adult cochlear implant recipients with far advanced otosclerosis. Laryngoscope Investig Otolaryngol 2022; 8:220-229. [PMID: 36846428 PMCID: PMC9948588 DOI: 10.1002/lio2.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives The objective of this study was to predict occurrence of facial nerve stimulation (FNS) in cochlear implanted patients for far-advanced otosclerosis (FAO) by correlating preoperative computed tomography (CT)-scan data to FNS and to evaluate FNS impact on hearing outcomes. Methods Retrospective analysis on 91 ears (76 patients) implanted for FAO. Electrodes were straight (50%) or perimodiolar (50%). Demographic data, extension of otosclerosis on preoperative CT scan, occurrence of FNS, and speech performance were analyzed. Results Prevalence of FNS was 21% (19 ears). FNS appeared during the first month (21%), 1-6 months (26%), 6-12 months (21%), and over 1 year (32%) postimplantation. Cumulative incidence of FNS at 15 years was 33% (95% CI = [14-47%]). Extension of otosclerotic lesions on preimplantation CT-scan was more severe in FNS ears compared to No-FNS (p < .05): for Stage III, 13/19 (68%) and 18/72 (25%) ears for FNS and No-FNS groups, respectively (p < .05). Location of otosclerotic lesions relative to the facial nerve canal was similar whatever the presence or not of FNS. Electrode array had no impact on FNS occurrence. At 1 year post-implantation, duration of profound hearing loss (≥5 years) and previous stapedotomy were negatively associated with speech performance. FNS did not impact hearing outcomes, despite a lower percentage of activated electrodes (p < .01) in the FNS group. Nevertheless, FNS were associated with a decrease of speech performance both in quiet (p < .001) and in noise (p < .05). Conclusion Cochlear implanted patients for FAO are at greater risk of developing FNS affecting speech performance over time, probably due to a higher percentage of deactivated electrodes. High resolution CT-scan is an essential tool allowing FNS prediction but not time of onset. Level of evidence 2b, Laryngoscope Investigative Otolaryngology, 2022.
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Affiliation(s)
- Maria‐Pia Tuset
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | - Amandine Baptiste
- Département de Biostatistique, Santé Publique et Information médicale, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | | | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Ghizlène Lahlou
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
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Management of Juvenile Otosclerosis: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111787. [PMID: 36421236 PMCID: PMC9688878 DOI: 10.3390/children9111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
Background. Otosclerosis can occur during childhood, resulting in the early onset of conductive hearing loss. The approach to a child with otosclerosis can present some difficulties in terms of diagnosis and treatment, and the literature on juvenile otosclerosis (JO) is still relatively limited. Aim. To explore the current approaches to JO, in order to clear the management of this condition and evaluate the outcomes and the possible complications of surgical treatment. Methods. A systematic review was performed according to PRISMA guidelines, searching Medline and Embase from January 2002 through to 30 September 2022. A total of 759 papers were identified but based on specified criteria, nine were included in this study. Results. There were 94 children affected by JO and treated by stapes surgery. According to the available data, Male: Female ratio was 1:3−4, whilst the mean ages ranged from 10 to 16.3 years at the time of stapes surgery. After stapes surgery, the target of ABG < 10 dB was achieved in most of the patients. Overall, the 4 complications were reported (4/94= 4%): stenosis of the external ear canal, deterioration of hearing, anacusis with vertigo, tinnitus. Conclusions. The heterogeneity of the available studies does not allow us to draw straight conclusions on this topic, currently. More data about the natural history of the disease in children could help in approaching the treatment correctly, and possibly in drawing guidelines. Studies with a prolonged follow-up could be helpful for assisting clinicians and families in taking the most favorable decision about treatment.
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Wells D, Knoll RM, Kozin E, Chen JX, Reinshagen KL, Staecker H, Curtin HD, McKenna MJ, Nadol JB, Quesnel AM. Otopathologic and Computed Tomography Correlation of Internal Auditory Canal Diverticula in Otosclerosis. Otol Neurotol 2022; 43:e957-e962. [PMID: 36075107 PMCID: PMC9771591 DOI: 10.1097/mao.0000000000003665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology. METHODS One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC. RESULTS Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001). CONCLUSION IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.
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Affiliation(s)
- Dawson Wells
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Renata M. Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Elliott Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Jenny X. Chen
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | | | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear, Boston, MA
| | | | - Joseph B. Nadol
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
| | - Alicia M. Quesnel
- Department of Otolaryngology, Harvard Medical School, Boston, MA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA
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Khaksari F, Dalili Kajan Z, Jalali MM, Khosravifard N. The Relationship Between Temporal Bone Pneumatization Pattern and Sinus Mucosal Thickness Grading on Computed Tomography Scans of Paranasal Sinuses. Indian J Otolaryngol Head Neck Surg 2022; 74:1532-1539. [PMID: 36452698 PMCID: PMC9702416 DOI: 10.1007/s12070-021-02665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022] Open
Abstract
The relationship between temporal bone pneumatization (TBP) pattern and sinus mucous thickness grading on computed tomography scans of paranasal sinuses was investigated. In this cross-sectional study, a total of 200 temporal bones and paranasal sinuses were evaluated in CT scans of 100 patients with chronic sinusitis (CRS). The mucosal thickness of paranasal sinuses was classified into two groups (0-6 and 7-12) according to the Lund-Mackay (LM) staging system. Also, pneumatization patterns of petrous apex and perilabyrinthine regions were classified according to Jadvah et al. method. Data were analyzed using Chi-square and Fisher's exact tests. The most common pneumatization pattern in the petrous apex was pattern A (49.5%) and in the perilabyrinthine region was pattern B (50%). In the petrous apex, the highest frequencies of pattern A (51.7%) and pattern C (24.6%), among other pneumatization patterns, were found in score range of 7-12 and 0-6, respectively, which was statistically significant (P = 0.017). Although in the perilabyrinthine region, the highest frequencies of pattern A (24.1%) and pattern C (32.7%) were in LM score ranges of 7-12 and 0-6, respectively, no significant difference was found (P = 0.589). The petrous apex pneumatization decreases with an increase in the severity of CRS, which can be in response to the eustachian tube dysfunction and common pathogens with CRS. A similar relationship was also found in the perilabyrinthine region, although it was not statistically significant. No significant relationship between TBP and severity of CRS was found in the age and sex groups.
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Affiliation(s)
- Farnoosh Khaksari
- Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Dalili Kajan
- Research Center of Allergic Diseases of Nose and Sinuses, Department of Maxillofacial Radiology, Dental School, End of Professor Samii Blvd, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir Mohammad Jalali
- Research Center of Allergic Diseases of Nose and Sinuses, Department of Otorhinology, Guilan University of Medical Sciences, Rasht, Iran
| | - Negar Khosravifard
- Dental Sciences Research Center, Department of Maxillofacial Radiology, Guilan University of Medical Sciences, Rasht, Iran
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Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:581-588. [PMID: 36032908 PMCID: PMC9411290 DOI: 10.1007/s12070-021-02428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022] Open
Abstract
To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9 years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29 mm preoperatively and a cut off value of 1.325 mm found using receiver operating characteristic curve method classifying OWN height as narrow or normal. Mean ISL measured pre operatively was 4.25 mm and mean length of prosthesis used was 4.56 mm with significant positive correlation using intraclass correlation coefficient method with correlation coefficient = 0.879. HRCT is an invaluable modality aiding the surgeon to detect otosclerotic foci with high sensitivity, identify thick obliterative otosclerotic foci requiring additional drilling, to predict the length of prosthesis used and to predict difficulties in approaching footplate when OWN height is below 1.325 mm.
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Computed Tomography Density as a Bio-marker for Histologic Grade of Otosclerosis: A Human Temporal Bone Pathology Study. Otol Neurotol 2022; 43:e605-e612. [PMID: 35761453 DOI: 10.1097/mao.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Computed tomography (CT) density measurement can be used to objectively distinguish otosclerosis from normal bone and to determine histologic grades of otosclerosis. BACKGROUND Otosclerosis can be seen on CT as subtle radiolucent areas. An objective radiologic measurement that corresponds to known otosclerosis pathology may improve diagnostic accuracy, and could be used as a radiologic biomarker for otosclerosis grade. METHODS A blinded, randomized evaluation of both histologic grade on histopathology slides and CT density measurement was performed on 78 human temporal bone specimens (31 with otosclerosis and 47 controls) that had undergone high-resolution multi-detector CT before histologic processing. Assessments were performed at 11 regions of interest (ROIs) in the otic capsule for each specimen. RESULTS The CT density measurement mean (Hounsfield Units) ± standard deviation for all ROIs (Nos. 1-9) was 2245 ± 854 for grade 0 (no otosclerosis, n = 711), 1896 ± 317 for grade 1 (inactive otosclerosis, n = 109), and 1632 ± 255 for grades 2 and 3 combined (mixed/active otosclerosis, n 35). There was a strong inverse correlation of CT density to histologic grade at ROIs Nos. 1-5 (ANOVA, p < 0.0001). The inter-rater reliability for CT density was very good (correlation coefficient 0.87, p < 0.05). ROC curves suggested a cut-off of 2,150HU to distinguish otosclerosis from normal bone, and 1,811HU to distinguish low grade from mixed/high grade otosclerosis. CONCLUSIONS In human temporal bone specimens, CT density may be used to distinguish normal bone from bone involved by otosclerosis. A higher histologic grade (i.e., indicating a more active otosclerotic focus) correlated with lower density.
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Walker BA, Thorwarth RM, Stull LL, Hoxworth JM, Deep NL, Weisskopf PA. Incidence of Concomitant Semicircular Canal Dehiscence With Otosclerosis. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e012. [PMID: 38516327 PMCID: PMC10950147 DOI: 10.1097/ono.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 03/23/2024]
Abstract
Objective The concurrence of otosclerosis and superior semicircular canal dehiscence (SSCD) presents a diagnostic challenge and failure to differentiate between these 2 diagnoses results in mischaracterization and unsuccessful surgery. The objective of this study is to identify the incidence of SSCD in patients who have computed tomography (CT) evidence of otosclerosis. Study Design Retrospective chart review. Setting Tertiary referral hospital. Patients Adults with CT scan of the temporal bone diagnosed with radiological unilateral or bilateral fenestral otosclerosis from January 1995 to April 2018. Methods Retrospective review of patient imaging from a multi-center tertiary-referral health system from January 1995 to April 2018. Imaging was reviewed to quantify the incidence of SSCD among patients with CT-diagnosed bilateral fenestral otosclerosis. Poor quality imaging was excluded from review. Results One-thousand two-hundred eight patients (1214 CT scans) were identified with otosclerosis, of which 373 were diagnosed with fenestral otosclerosis (663 ears) with imaging of sufficient quality for review. This population was predominantly female (57.2%) with bilateral fenestral otosclerosis (78%). Of these, 23 ears (3.5%) had definitive evidence of SSCD, with an additional 15 ears (2.3%) with possible radiographic evidence of SSCD. There was no significant difference in laterality between the SSCD and otosclerosis. Conclusions Among 373 patients with fenestral otosclerosis per CT temporal bone imaging at a tertiary referral hospital, as many as 8.3% of patients had radiographic evidence of SSCD. Given this incidence, it continues to be important to consider SSCD when diagnosing and treating otosclerosis.
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Affiliation(s)
- Brian A. Walker
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Ryan M. Thorwarth
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Lindsey L. Stull
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Joseph M. Hoxworth
- Department of Radiology, Division of Neuroradiology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Nicholas L. Deep
- Department of Otorhinolaryngology, Division of Neurotology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Peter A. Weisskopf
- Department of Otorhinolaryngology, Division of Neurotology, The Mayo Clinic in Arizona, Phoenix, AZ
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Wu H, Fang J, Liu Y, Wang J, Chen Z, Wang J, Shi H. Generation of an integration-free induced pluripotent stem cell line (JTUi004-A) from an otosclerosis patient. Stem Cell Res 2022; 61:102783. [DOI: 10.1016/j.scr.2022.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
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Wiatr A, Szpak K, Składzień J, Wiatr M. Otosclerosis – analysis of factors influencing the improvement of hearing after surgical treatment. Otolaryngol Pol 2022; 76:1-6. [DOI: 10.5604/01.3001.0015.8248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Otosclerosis is a disease that occurs only in humans, in the course of which there are foci of pathological ossification in the temporal bone. The etiology of the dise ase is not fully understood. Treatment of the conductive component of hearing loss is surgical. The results of the treatment are influenced by factors related to the surgery, the local condition of the middle ear and the function of the inner ear. </br></br> <b>Aim:</b> The aim of the study is to identify factors influencing the improvement of hearing in patients treated surgically due to otosclerosis. </br></br> <b>Material and methods:</b> The study included patients who underwent otosclerosis for the first middle ear surgery and under-went stapedotomy. Considering the factors that may affect the outcome of surgical treatment, the patients qualified for the analysis were divided into subgroups. All patients underwent a medical history and physical examination of otorhinolaryn-gology and a complete set of audiological examinations. </br></br> <b> Results:</b> A statistically significant reduction in cochlear reserve was observed in all patients after stapedotomy. The be-neficial effect of the performed treatment on the improvement of threshold values of bone conduction in patients with mild sensorineural hearing loss was also confirmed. Intraoperative removal of adhesions present in the tympanic cavity significantly improved hearing in terms of bone conduction values, especially at 500 Hz. </br></br> <b> Conclusions:</b> (1) The conducted study confirmed the influence of factors related to the local condition of the middle ear lining on the final result of otosclerosis surgery; (2) Audiometric markers of cochlear otosclerosis, observed before surgical treat-ment, are an unfavorable factor in the improvement of hearing after the performed treatment.
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Affiliation(s)
- Agnieszka Wiatr
- Chair and Clinic of Otolaryngology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Kamila Szpak
- Clinical Department of Otolaryngology, University Hospital in Krakow, Poland
| | - Jacek Składzień
- Chair and Clinic of Otolaryngology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Maciej Wiatr
- Audiological Laboratory, Department of Otolaryngology, Jagiellonian University Collegium Medicum, Krakow, Poland
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Microscopic Versus Endoscopic Stapes Surgery: A Systematic Review and Metanalysis. The Journal of Laryngology & Otology 2022; 136:1014-1022. [PMID: 35012693 DOI: 10.1017/s0022215121004436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cochlear Implantation in Advanced Otosclerosis: Pitfalls and Successes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
This review will highlight recent outcome-based evidence guiding decision making for cochlear implantation in advanced otosclerosis, related complications, and technical surgical considerations in otosclerosis and the obstructed cochlea.
Recent Findings
Cochlear implantation in advanced otosclerosis results in consistent, excellent auditory outcomes with improvement in both objective speech recognition scores and subjective quality of life measures. Facial nerve stimulation may occur at higher rates in otosclerosis cochlear implant recipients. Cochlear implantation in the setting of luminal obstruction in osteosclerotic patients may be managed with altered surgical technique to achieve successful auditory improvements. Pre-operative imaging with high resolution CT or MRI may help anticipate intraoperative challenges and post-operative complications in cochlear implantation.
Summary
Cochlear implantation is an established, successful treatment for profound hearing loss in advanced otosclerosis. Surgeon knowledge of outcomes, complications, and potential surgical challenges is important to appropriately counsel patients regarding auditory rehabilitation options in advanced otosclerosis.
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Conway RM, Sioshansi PC, Babu SC, Tu NC, Schettino AE, Bojrab DI, Schutt CA. Audiologic Outcomes of Footplate Drillout for Obliterative Otosclerosis. Otol Neurotol 2022; 43:29-35. [PMID: 34619729 DOI: 10.1097/mao.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the audiologic outcomes of microdrill fenestration for obliterative otosclerosis compared to traditional stapedotomy technique. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adult patients undergoing stapedotomy for otosclerosis. MAIN OUTCOME MEASURES Patients were separated into groups that underwent either microdrill or laser fenestration based on intraoperative severity of disease. Audiologic outcomes and complications were compared between the two groups. RESULTS There were 588 ears in 519 patients that were evaluated. There was a significant postoperative improvement in pure tone average, air-bone gap, and mean bone conduction thresholds for both the obliterative and nonobliterative group (p < 0.001). There was no significant difference in the pre- or postoperative hearing status between the two groups. There was no significant difference in complications between the two groups, including no cases of postoperative profound hearing loss in the drill fenestration group. CONCLUSIONS Audiologic outcomes are similar between microdrill fenestration and laser fenestration for otosclerosis. Pure tone average, air-bone gap, and mean bone conduction thresholds all improved postoperatively and were similar between groups.
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Affiliation(s)
- Robert M Conway
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights
| | - Pedrom C Sioshansi
- Department of Otolaryngology - Head & Neck Surgery Wake Forest University School of Medicine Winston-Salem, NC
| | | | - Nathan C Tu
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, NY
| | - Amy E Schettino
- Department of Otolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philidelphia, Pennsylvania
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Casselman JW, Vanden Bossche S, De Foer B, Bernaerts A, Dekeyzer S. Temporal Bone. Clin Neuroradiol 2022. [DOI: 10.1007/978-3-319-61423-6_90-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Hodge SE, Ishiyama G, Lopez IA, Ishiyama A. Histopathologic Analysis of Temporal Bones With Otosclerosis Following Cochlear Implantation. Otol Neurotol 2021; 42:1492-1498. [PMID: 34607995 PMCID: PMC8595606 DOI: 10.1097/mao.0000000000003327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Analyze changes in osteoneogenesis and fibrosis following cochlear implant (CI) surgery in patients with otosclerosis and compare differences based on insertion technique. BACKGROUND When advanced otosclerotic disease extends to the otic capsule, severe and profound sensorineural hearing loss necessitates consideration of a cochlear implant. Histopathological analysis of the human temporal bone after implantation in the patient with otosclerosis may reveal important variables that predict CI success. METHODS Histopathological evaluation of archival human temporal bones from subjects with a history of CI for cochlear otosclerosis. A total of 17 human temporal bones (HTB) were analyzed, 13 implanted, and 4 contralateral non-implanted controls. RESULTS Histopathological studies revealed extensive osteoneogenesis and fibrosis which was more prominent at the cochleostomy insertion site in the basal turn of the cochlea often obliterating the scala tympani in the basal turn, and in some cases extending to the scala media and scala vestibuli. Cochlear hydrops was nearly universal in these cases. This contrasted with the round window insertion, which exhibited minimal osteoneogenesis within the cochlear duct. In addition, in the contralateral, unimplanted control ears, there was otosclerosis at the stapes footplate, fissula ante fenestrum but no osteoneogenesis within the cochlear duct. CONCLUSION Cochleostomy approach to CI insertion in otosclerosis patients is associated with significant fibrosis, osteoneogenesis, and cochlear hydrops. A round window insertion technique can be utilized to help minimize these histopathologic findings whenever feasible.
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Affiliation(s)
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Ivan A Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Fang Y, Zhang K, Ersbo JH, Chen B. The Impact of the Frequency-Specific Preoperative Sensorineural Hearing Loss to Postoperative Overclosure of Bone Conduction in Stapedotomy. Otol Neurotol 2021; 42:1314-1322. [PMID: 34528921 DOI: 10.1097/mao.0000000000003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the frequency-specific relationships between the preoperative sensorineural hearing loss and postoperative overclosure of bone conduction (BC) threshold after stapedotomy. METHODS We conducted a retrospective analysis of 207 otosclerosis patients who underwent stapedotomy in our hospital. Pre- and postoperative audiometry were collected between patients with or without preoperative sensorineural hearing loss (SNHL) component (i.e., SNHL group and non-SNHL group, respectively). Overclosure rate (OR), deterioration rate (DR), and their significant values (i.e., SOR or SDR) were compared between the sub-groups at each frequency to access the frequency-specific outcomes. RESULTS There were 69 patients in non-SNHL group and 138 patients in SNHL group. Postoperative success rate was similar in non-SNHL group and SNHL group. For frequency-specific outcomes, both the OR and SOR were significantly obvious in all SNHL subgroups than those in non-SNHL subgroups (p < 0.001), except at 4 kHz for SOR. Extent of overclosure and significant overclosure were more obvious in SNHL subgroups than those in non-SNHL subgroups (p < 0.01). The DR and SDR of BC were significantly obvious at 1k to 4 kHz in non-SNHL subgroups than those in SNHL subgroups (p < 0.01), however, not so for the extent of deterioration (p > 0.05). Frequency-specific success rate was similar at each frequency. CONCLUSION Stapedotomy was efficient and safe in patients with or without SNHL component preoperatively. Frequency-specific overclosure effect was more obvious in all tone frequencies in SNHL subgroups than those in non-SNHL subgroups. For frequency-specific outcomes, about 50% BC with preoperative SNHL component at tone frequency meet postoperative significant overclosure effect, which was most obvious at low frequencies.
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Affiliation(s)
- Yanqing Fang
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology.,Institutes of Biomedical Sciences.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Kun Zhang
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology.,Institutes of Biomedical Sciences.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jack H Ersbo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology.,Institutes of Biomedical Sciences.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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Zhang Y, Tang Q, Xue R, Zhu X, Yang H, Gao Z. Analysis of the Genetic Characteristics of a Chinese Family With Otosclerosis. EAR, NOSE & THROAT JOURNAL 2021; 100:774S-780S. [PMID: 32126815 DOI: 10.1177/0145561320910627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Otosclerosis is a focal lesion of the inner ear. The role of genetic factors in the pathogenesis of otosclerosis has received increasing attention. We analyzed the clinical manifestations, inheritance pattern, and pathogenic genes in a family with otosclerosis. METHODS We collected clinical data and generated a family pedigree. High-throughput second-generation sequencing technology was used to identify candidate genes by performing whole-exome sequencing of 7 members of the family, and Sanger sequencing was performed to validate candidate gene mutations in the 7 family members. RESULTS Otosclerosis was characterized by autosomal dominant inheritance in this family. Whole-exome sequencing did not reveal mutation sites in known deafness-related genes. However, a c.2209A > G (p.T737A) mutation was detected in exon 6 of the SP1 gene, which is associated with the COL1A1 gene. This mutation was a pathogenic mutation, and Sanger sequencing confirmed that this mutation cosegregated with the clinical phenotype among the family members. CONCLUSIONS The pattern of otosclerosis in this family is consistent with autosomal dominant inheritance, and the SP1 gene, harboring the c.2209A > G (p.T737A) mutation in exon 6, may be the causative gene of otosclerosis in this family.
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Affiliation(s)
- Yongli Zhang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
| | - Qi Tang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
| | - Ruoyan Xue
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
| | - Xiaohui Zhu
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
| | - Hua Yang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, 34732Peking Union Medical College Hospital, Beijing, China
- Translational Medicine Center, 34732Peking Union Medical College Hospital, Beijing, China
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Deng F, Touska P, Reinshagen KL, Curtin HD, Juliano AF. Diagnostic Performance of Conebeam CT Pixel Values in Active Fenestral Otosclerosis. AJNR Am J Neuroradiol 2021; 42:1667-1670. [PMID: 34140277 DOI: 10.3174/ajnr.a7192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative bone densitometry on multidetector CT of the temporal bone is a diagnostic adjunct for otosclerosis in its active (spongiotic) phase, but translating this technique to conebeam CT is limited by the technical variability of conebeam CT pixel values. The purpose of this study was to evaluate the performance of internally calibrated conebeam CT pixel value measurements that can enable the determination of active fenestral otosclerosis (otospongiosis). MATERIALS AND METHODS This study included 37 ears in 22 patients with a clinical diagnosis of otospongiosis in those ears and 35 ears in 22 control patients without the diagnosis. Temporal bone conebeam CT was performed. ROIs were set anterior to the oval window, in the lateral semicircular canal bone island, and in a nearby aerated space. Mean conebeam CT pixel values in these regions determined the relative attenuation ratio of the area anterior to the oval window normalized to normal otic capsule bone and air. RESULTS The relative attenuation ratio for cases of otospongiosis was significantly lower than that for controls (P < .001). Based on receiver operating characteristic analysis, the optimal cutoff relative attenuation ratio was 0.876, which had an accuracy of 97.2% for the diagnosis of otospongiosis. CONCLUSIONS Internally calibrated pixel value ratios in temporal bone conebeam CT can feasibly help diagnose active/spongiotic-phase fenestral otosclerosis in an objective manner.
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Affiliation(s)
- F Deng
- From the Department of Radiology (F.D.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Touska
- Department of Radiology (P.T), Guy's Hospital, Guy's and St. Thomas' Hospitals National Health Service Foundation Trust, London, UK
| | - K L Reinshagen
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - H D Curtin
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - A F Juliano
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Clarke-Brodber AL, Taxy JB. The Stapes in Otosclerosis: Osteoarthritis of an Ear Ossicle. Head Neck Pathol 2021; 15:737-742. [PMID: 33415516 PMCID: PMC8384928 DOI: 10.1007/s12105-020-01269-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Otosclerosis is a pagetoid proliferation of bone remodeling, vascular proliferation, bone resorption and new bone formation in the tympanic region of the temporal bone. The resulting anklyosis of the stapes footplate as it articulates with the oval window is the most common cause of conductive hearing loss in young to middle aged, predominantly Caucasian individuals. The characteristic histologic features have been well documented by autopsy studies of the temporal bone. Although stapedectomy is the surgical treatment for otosclerosis, the stapes specimen may be submitted for gross examination only or not examined at all. A retrospective study of 73 stapedectomy specimens (2008-2019) not including the stapes footplate. Clinical features from the electronic medical record as well as standard histologic sections from surgical specimens were reviewed. Neither the stapedal head nor crura showed histologic features of otosclerosis. There was mild osteoarthritis affecting the head, possibly as a consequence of persistent ossicular vibration superimposed on the ankylosed rigidity. The most common changes were surface fissuring (65%), cartilaginous erosion (49%) and irregularity of the osteochondral interface (51%). An occasional osteophyte (8%) was observed. The ear ossicles, embryologically analogous to long bones of the extremities, develop via endochondral ossification and exhibit articular surfaces of hyaline cartilage. The present observations suggest that a consequence of otosclerotic ankylosis is osteoarthritis of the stapedal head. In this study, the histological features could not be correlated with the severity of hearing loss or duration of clinical disease.
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Affiliation(s)
- Anna-Lee Clarke-Brodber
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, 2650 Ridge, Evanston, IL 60201 USA
- University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Jerome B. Taxy
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, 2650 Ridge, Evanston, IL 60201 USA
- University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
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Højland AT, Tavernier LJM, Schrauwen I, Sommen M, Topsakal V, Schatteman I, Dhooge I, Huber A, Zanetti D, Kunst HPM, Hoischen A, Petersen MB, Van Camp G, Fransen E. A wide range of protective and predisposing variants in aggrecan influence the susceptibility for otosclerosis. Hum Genet 2021; 141:951-963. [PMID: 34410490 DOI: 10.1007/s00439-021-02334-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022]
Abstract
In this study, we investigated the association of ACAN variants with otosclerosis, a frequent cause of hearing loss among young adults. We sequenced the coding, 5'-UTR and 3'-UTR regions of ACAN in 1497 unrelated otosclerosis cases and 1437 matched controls from six different subpopulations. The association between variants in ACAN and the disease risk was tested through single variant and gene-based association tests. After correction for multiple testing, 14 variants were significantly associated with otosclerosis, ten of which represented independent association signals. Eight variants showed a consistent association across all subpopulations. Allelic odds ratios of the variants identified four predisposing and ten protective variants. Gene-based tests showed an association of very rare variants in the 3'-UTR with the phenotype. The associated exonic variants are all located in the CS domain of ACAN and include both protective and predisposing variants with a broad spectrum of effect sizes and population frequencies. This includes variants with strong effect size and low frequency, typical for monogenic diseases, to low effect size variants with high frequency, characteristic for common complex traits. This single-gene allelic spectrum with both protective and predisposing alleles is unique in the field of complex diseases. In conclusion, these findings are a significant advancement to the understanding of the etiology of otosclerosis.
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Affiliation(s)
- Allan Thomas Højland
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Research and Knowledge Center in Sensory Genetics, Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Lisse J M Tavernier
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Isabelle Schrauwen
- Center for Statistical Genetics, Department of Neurology, Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Manou Sommen
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Vedat Topsakal
- Department of ORL and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Isabelle Schatteman
- European Institute for ORL, St-Augustinus Hospital Antwerp, Antwerp, Belgium
| | - Ingeborg Dhooge
- Department of Otolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Alex Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Diego Zanetti
- Department of Clinical Sciences and Community Health, Audiology Unit, University of Milan, I.R.C.C.S. Fondazione "Cà Granda", Osp.Le Maggiore Policlinico, Milano, Italy
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Otorhinolaryngology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander Hoischen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Otorhinolaryngology, Hearing and Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael B Petersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Research and Knowledge Center in Sensory Genetics, Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Guy Van Camp
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
| | - Erik Fransen
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium. .,StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium.
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Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker. Otol Neurotol 2021; 42:985-993. [PMID: 34260505 DOI: 10.1097/mao.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed. MAIN OUTCOME MEASURES Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes. RESULTS Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p < 0.001, p = 0.0214, and p = 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20-30 dB or >30 dB preoperative ABG, p = 0.0292, Fisher's exact test). This tendency was not significant for relHI (p = 0.074). CONCLUSIONS Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.
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Poutoglidis A, Tsetsos N, Vardaxi C, Fyrmpas G, Poutoglidou F, Kilmpasanis A, Vlachtsis K. Conventional Microscopic Stapedotomy: An Obsolete Technique or Still the Gold Standard for the Management of Otosclerosis? Cureus 2021; 13:e14126. [PMID: 33927934 PMCID: PMC8075829 DOI: 10.7759/cureus.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Clinical otosclerosis is a relatively common entity, accounting for 0.5%-2% of the general population. Otosclerosis is characterized by an abnormal bone formation in the temporal bone that eventually causes conductive hearing loss. Bilateral involvement is fairly common. Treatment can be either conservative with medications and a hearing aid, or surgical. Stapedotomy is considered, nowadays, the most effective surgical technique for the management of otosclerosis. The purpose of the present study is to present our long-term results with stapedectomy, the audiological outcome, as well as the complications encountered. Subjects and methods This is a retrospective single-centre study. All patients diagnosed with otosclerosis and treated operatively with a stapedotomy from January 2010 to December 2019 were included in the study. Demographic data, air and bone conduction thresholds, complications and length of the prosthesis were recorded. Results The study included a total of 72 patients. The audiological results showed a statistically significant improvement in the air conduction thresholds in all the affected frequencies (p<0.001). Post-operative complications included deterioration or severe hearing loss up to 100 dB (n=1, 1.39%), loss or distortion of taste (n=4, 5.6%) and tinnitus (n=2, 2.8%). Conclusions Our results demonstrate that stapedotomy is an effective technique for the management of otosclerosis. Stapedotomy, when performed by an experienced surgeon, provides excellent outcomes, with limited complications.
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Affiliation(s)
- Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Chrysa Vardaxi
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Frideriki Poutoglidou
- Department of Clinical Pharmacology, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Adamantios Kilmpasanis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Konstantinos Vlachtsis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
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Xu K, Bai X, Chen S, Xie L, Qiu Y, Li H, Sun Y. CCDC154 Mutant Caused Abnormal Remodeling of the Otic Capsule and Hearing Loss in Mice. Front Cell Dev Biol 2021; 9:637011. [PMID: 33614666 PMCID: PMC7889813 DOI: 10.3389/fcell.2021.637011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
Osteopetrosis is a rare inherited bone disease characterized by dysfunction of osteoclasts, causing impaired bone resorption and remodeling, which ultimately leads to increased bone mass and density. Hearing loss is one of the most common complications of osteopetrosis. However, the etiology and pathogenesis of auditory damage still need to be explored. In this study, we found that a spontaneous mutation of coiled-coil domain-containing 154 (CCDC154) gene, a new osteopetrosis-related gene, induced congenital deafness in mice. Homozygous mutant mice showed moderate to severe hearing loss, while heterozygous or wild-type (WT) littermates displayed normal hearing. Pathological observation showed that abnormal bony remodeling of the otic capsule, characterized by increased vascularization and multiple cavitary lesions, was found in homozygous mutant mice. Normal structure of the organ of Corti and no substantial hair cell or spiral ganglion neuron loss was observed in homozygous mutant mice. Our results indicate that mutation of the osteopetrosis-related gene CCDC154 can induce syndromic hereditary deafness in mice. Bony remodeling disorders of the auditory ossicles and otic capsule are involved in the hearing loss caused by CDCC154 mutation.
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Affiliation(s)
- Kai Xu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Bai
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sen Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Xie
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Qiu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - He Li
- Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fujima N, Andreu-Arasa VC, Onoue K, Weber PC, Hubbell RD, Setty BN, Sakai O. Utility of deep learning for the diagnosis of otosclerosis on temporal bone CT. Eur Radiol 2021; 31:5206-5211. [PMID: 33409781 DOI: 10.1007/s00330-020-07568-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/24/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Diagnosis of otosclerosis on temporal bone CT images is often difficult because the imaging findings are frequently subtle. Our aim was to assess the utility of deep learning analysis in diagnosing otosclerosis on temporal bone CT images. METHODS A total of 198 temporal bone CT images were divided into the training set (n = 140) and the test set (n = 58). The final diagnosis (otosclerosis-positive or otosclerosis-negative) was determined by an experienced senior radiologist who carefully reviewed all 198 temporal bone CT images while correlating with clinical and intraoperative findings. In deep learning analysis, a rectangular target region that includes the area of the fissula ante fenestram was extracted and fed into the deep learning training sessions to create a diagnostic model. Transfer learning was used with the deep learning model architectures of AlexNet, VGGNet, GoogLeNet, and ResNet. The test data set was subsequently analyzed using these models and by another radiologist with 3 years of experience in neuroradiology following completion of a neuroradiology fellowship. The performance of the radiologist and the deep learning models was determined using the senior radiologist's diagnosis as the gold standard. RESULTS The diagnostic accuracies were 0.89, 0.72, 0.81, 0.86, and 0.86 for the subspecialty trained radiologist, AlexNet, VGGNet, GoogLeNet, and ResNet, respectively. The performances of VGGNet, GoogLeNet, and ResNet were not significantly different compared to the radiologist. In addition, GoogLeNet and ResNet demonstrated non-inferiority compared to the radiologist. CONCLUSIONS Deep learning technique may be a useful supportive tool in diagnosing otosclerosis on temporal bone CT. KEY POINTS • Deep learning can be a helpful tool for the diagnosis of otosclerosis on temporal bone CT. • Deep learning analyses with GoogLeNet and ResNet demonstrate non-inferiority when compared to the subspecialty trained radiologist. • Deep learning may be particularly useful in medical institutions without experienced radiologists.
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Affiliation(s)
- Noriyuki Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
- Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Keita Onoue
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Peter C Weber
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Richard D Hubbell
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Bindu N Setty
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA.
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Analysis of temporal bone thickness outside of the petrous temporal bone between superior semicircular canal dehiscence and normal patients. J Clin Neurosci 2020; 84:23-28. [PMID: 33485593 DOI: 10.1016/j.jocn.2020.12.011] [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: 06/25/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND SSCD is a rare inner ear disorder. This study aims to compare the thickness of the temporal bone beyond the petrous portion between healthy subjects and those with SSCD to determine whether the etiopathology of SSCD is localized to the petrous temporal bone or generalized to other parts of the temporal bone. METHODS A retrospective chart review of electronic medical records from September 2011 to February 2018 was conducted at a single-institution study at the University of California, Los Angeles. Participants were divided into two groups: Group 1 had a confirmed diagnosis of SSCD, while Group 2 had no known ear or temporal bone pathology. Participants' high-resolution coronal and axial temporal bone computed tomography scans were analyzed. Regions within the temporal bone were measured and compared between the two groups. RESULTS A total of 262 scans were included. Group 1 consisted of 103 scans, while Group 2 consisted of 159 scans. There was no statistically significant difference in the thickness of temporal bones between patients diagnosed with SSCD and patients without otologic disease. CONCLUSION The results suggest that the etiology of SSCD is limited to the petrous portion of the temporal bone. SSCD may be unrelated to a larger process of global temporal bone degeneration. Additional clinical screening for regions outside the petrous temporal bone is not warranted unless SSCD patients present with symptoms characteristic of other temporal bone pathologies.
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Wiatr A, Job K, Składzień J, Wiatr M. Impact of surgery in otosclerosis on the non-operated ear. Otolaryngol Pol 2020; 75:15-20. [PMID: 33949316 DOI: 10.5604/01.3001.0014.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart's notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart's notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author's own studies by an average of 5 dB in the low-frequency range.
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Affiliation(s)
- Agnieszka Wiatr
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
| | | | - Jacek Składzień
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
| | - Maciej Wiatr
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
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Ehrmann-Müller D, Shehata-Dieler W, Kaulitz S, Back D, Kurz A, Kühn H, Hagen R, Rak K. Cochlear implantation in children without preoperative computed tomography diagnostics. Analysis of procedure and rate of complications. Int J Pediatr Otorhinolaryngol 2020; 138:110266. [PMID: 32866797 DOI: 10.1016/j.ijporl.2020.110266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To evaluate the safety in cochlear implantation without preoperative computed tomography diagnostics, which was implemented into the protocol of cochlear implantation in 2013, since in the year before, new evidence concerning the risks of ionizing radiation especially in children arose. METHODS In this retrospective data analysis 89 children under 36 months, which were cochlear implanted from 2008 until 2018 at a tertiary referral centre with a large cochlear implant program were analysed. Fortyfour of the children were implanted before the date of change in 2013 and 45 in the following years up to now. The data about the operative procedures, the postoperative care and the complication rate before and after implementation of the new protocol were compared. RESULTS Before the date of change in 2013, 100% of patients received preoperative CT diagnostics, in the following years 13.3%. No difference in the duration of surgery, the procedure related and the late complications between the two groups was identified. CONCLUSION Cochlear implantation in very young children under the age of 36 months without preoperative radiological diagnostics by CT scan of the temporal bone is a safe procedure without additional risks for the patients.
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Affiliation(s)
- Desiree Ehrmann-Müller
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Stefan Kaulitz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Daniela Back
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Anja Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Heike Kühn
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany.
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Akazawa Y, Ganaha A, Higa T, Kondo S, Oyakawa Y, Hirakawa H, Suzuki M, Yamashiro T. Measurement of stapes footplate thickness in otosclerosis by ultra-high-resolution computed tomography. Acta Otolaryngol 2020; 140:899-903. [PMID: 32700991 DOI: 10.1080/00016489.2020.1788225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultra-high-resolution computed tomography (U-HRCT) utilizes a 1024 × 1024 matrix with 0.25-mm section thickness, offering better spatial resolution than conventional multi-detector row CT to detect anatomic data for otologic surgery. AIMS We examined stapes footplate thickness using U-HRCT in relation to stapedotomy to predict the difficulty of the surgical procedure. MATERIALS AND METHODS Subjects were 12 otosclerosis patients and 25 controls who underwent diagnostic U-HRCT. A profile curve (Hounsfield units) was used to measure stapes footplate thickness along a perpendicular line across the stapes footplate in a plane parallel to the lateral semicircular canal. RESULTS Footplate thickness was smaller at the midpoint than just before the anterior crus and just after the posterior crus. Interobserver variability was lowest at the midpoint, where foot plate thickness was significantly greater in the affected ear in otosclerosis patients compared with controls (0.60 ± 0.09 mm vs 0.46 ± 0.04 mm; p < .001). Otosclerosis patients were detected using U-HRCT with a high area under the curve. Difficulty in the stapes opening procedure correlated with stapes footplate thickness. CONCLUSIONS Footplate thickness on U-HRCT correlated with temporal bone anatomy and corresponded to surgical difficulty. Significance: U-HRCT-derived anatomic data is useful for evaluating the stapes.
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Affiliation(s)
- Yukinori Akazawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Akira Ganaha
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan
| | - Teruyuki Higa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Shunsuke Kondo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Yoshiki Oyakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Japan
- Department of Radiology, Yokohama City University School of Medicine, Yokohama, Japan
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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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