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Massimilla EA, Testa D, Nunziata M, Donadio A, Romano ML, Motta G. Long Process Incus necrosis in Revision Stapedotomy: Retrospective Clinical Study. EAR, NOSE & THROAT JOURNAL 2023; 102:58-63. [PMID: 33393819 DOI: 10.1177/0145561320986047] [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] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES We describe our experience with long process incus (LPI) necrosis in revision stapedotomy and discuss the different management methods proposed in the literature to identify surgical techniques that can lead to satisfactory results over time. METHODS Twenty-two stapedotomy revisions, in 21 patients with the necrosis of the long process of the incus, are performed from 1997 to 2017. In cases of erosion or minimal necrosis of LPI, a new prosthesis of the same type or an angled prosthesis was applied higher on the residual incus stump. In cases of partial necrosis of LPI, a Donaldson type ventilation tube reshaped and placed on the residual incus stump to stabilize prosthesis, or glass ionomer bone cement was used. In cases of subtotal necrosis of LPI, a cup piston prosthesis in polycel was applied on incus residual stump. Pre- and postoperative (≥1 year) pure tone audiometry was performed for all cases. Air conduction threshold, bone conduction (BC) threshold, and air-bone gap (ABG) were documented according to the American Academy of Otolaryngology Head and Neck Surgery Committee of Hearing and Equilibrium guidelines. RESULTS At 1-year follow-up, postoperative ABG was reduced to ≤10 dB in 13 (59%) cases and ≤20 dB in 19 (86.4%) cases. The mean postoperative ABG significantly decreased in each group. There was no significant change in postoperative BC thresholds, and there were no cases with postoperative SNHL. CONCLUSION Excellent functional results can also be achieved in cases of long incus process necrosis. The choice of technique should be considered according to the degree of necrosis. Piston replacement with the same type or angled type prosthesis, in cases of erosion or minimal LPI necrosis, and modified Donaldson type ventilation tube, in cases of partial LPI necrosis, provided excellent hearing results.
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Affiliation(s)
- Eva Aurora Massimilla
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Domenico Testa
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Michele Nunziata
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Anna Donadio
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Maria Loreto Romano
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Gaetano Motta
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
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Schwam ZG, Schettino A, Bojrab DI, Babu SC, Michaelides EM, Schutt CA. Outcomes in primary and revision surgery for pediatric onset stapedial pathology. Am J Otolaryngol 2022; 43:103362. [PMID: 34972000 DOI: 10.1016/j.amjoto.2021.103362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To analyze audiometric outcomes of surgery for pediatric onset stapedial pathology (POSP). STUDY DESIGN Retrospective cohort study. SETTING Single-institution database. METHODS Retrospective analysis of 809 stapes procedures performed at a single high-volume tertiary referral otology practice, 75 of which were POSP cases. RESULTS Oval window drillout for thick footplate and aborting the procedure were more common in POSP cases compared to the rest of the cohort (28.0% versus 9.8% [p < .001] and 5.3% versus 1.2% [p = .007], respectively). Postoperative complications were rare. Postoperative Air-Bone Gap (pABG) closure to ≤20 dB was significantly lower in the POSP group (80.0% versus 89.0%, p = .021). Rates of sensorineural hearing loss (SNHL) were not different between the two groups. Poor audiometric outcomes in the POSP group were largely driven by revision cases; pABG≤10 dB was 60.3% in primary cases but only 11.8% in revisions (p < .001), and postoperative SNHL was significantly higher in revisions (29.4% versus 0.0%, p < .001). In multivariate analysis, POSP was not a predictor of successful closure of the pABG at either level, nor did it predict significant postoperative SNHL. CONCLUSIONS Surgery for pediatric onset stapedial pathology had significantly worse audiometric outcomes, particularly in revision cases, as compared to the rest of the cohort.
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Schwam ZG, Schettino A, Babu SC, Bojrab DI, Michaelides EM, Schutt CA. Outcomes in Revision Stapes Surgery. Otolaryngol Head Neck Surg 2021; 165:705-709. [PMID: 33560173 DOI: 10.1177/0194599821991479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. STUDY DESIGN Retrospective cohort study. SETTING Large single-institution database. METHODS Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. RESULTS Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to ≤20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P < .001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. CONCLUSIONS Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. LEVEL OF EVIDENCE 4 (retrospective observational research).
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Health System, New York, New York, USA
| | - Amy Schettino
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
| | - Elias M Michaelides
- Department of Otolaryngology-Head and Neck Surgery, Rush University, Illinois, USA
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
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Blijleven EE, Wegner I, Tange RA, Thomeer HGXM. Revision Stapes Surgery in a Tertiary Referral Center: Surgical and Audiometric Outcomes. Ann Otol Rhinol Laryngol 2019; 128:997-1005. [PMID: 31161780 PMCID: PMC6791027 DOI: 10.1177/0003489419853304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions. Methods: A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively. Results: In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, –2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another. Conclusions: Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.
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Affiliation(s)
- Esther E Blijleven
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rinze A Tange
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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Abstract
AbstractObjectiveThis paper highlights the importance of reporting air–bone gap closure in stapes surgery according to the American Academy of Otolaryngology – Head and Neck Surgery guidelines and reviews compliance in recent years.MethodsA retrospective case series was conducted and the outcomes were reviewed. Closure of the air–bone gap was calculated in 204 adult patients using the aforementioned guidelines. Results were recalculated ignoring the Carhart phenomenon to determine any significant difference. Adherence to guidelines was also reported as a secondary outcome.ResultsIgnoring the Carhart phenomenon resulted in 75 per cent over-reporting of successful air–bone gap closure (p< 0.001). Over-reporting occurred in 5.9 per cent of papers, and in 11.8 per cent it was difficult to determine how the results were reached.ConclusionDespite the existence of clear guidelines, stapes surgery outcomes are still being over-reported as successful. This can lead to incorrect information being provided to patients during the consent process and makes comparative studies difficult.
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Wegner I, Vincent R, Derks LSM, Rauh SP, Heymans MW, Stegeman I, Grolman W. An internally validated prognostic model for success in revision stapes surgery for otosclerosis. Laryngoscope 2018. [DOI: 10.1002/lary.27132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Laura S. M. Derks
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Simone P. Rauh
- Department of Epidemiology and Biostatistics; VU University Medical Centre, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics; VU University Medical Centre, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
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Abstract
Objectives. Surgery for otosclerosis has a highly satisfactory hearing outcome, for both the patient and the otologic surgeon. However, subsequent conductive hearing loss, dizziness/vertigo, or sound distortion could necessitate revision surgery. The aim of the present study is to evaluate the surgical findings and hearing outcomes of 84 revision stapes surgeries. Study Design. Case series with chart review. Setting. Tertiary referral center. Subjects and Methods. At our institution, 84 revision cases were performed between 1998 and 2009. Conductive hearing loss was the revision indication in 69 cases, severe dizziness/vertigo in 8 patients, sound distortion in 5 cases, and progressive hearing loss with dizziness in 2 patients. Operative findings were noted in every case and evaluated separately. Results. Surgical intervention revealed problems related to prosthesis in 51 cases, fibrotic bands in 26 cases, adhesions in 13 cases, incus necrosis in 15 cases, perilymphatic fistula in 3 cases, intact footplate in 5 cases, incus-malleus fixation in 2 cases, and reobliteration in 2 cases. Mean follow-up period was 19 months (range, 12-53 months). Successful hearing results (air-bone gap <10 dB) were reached in 58% of the cases, and satisfactory hearing results (air-bone gap <20 dB) were reached in 71% of the cases. Conclusions. The ideal patient for revision stapes surgery is one who benefits from the initial surgery but complained of conductive hearing loss. In the present study, improvement in pure-tone average was 13.2 dB, and the mean air-bone gap was 9.6 dB.
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Affiliation(s)
- Mehmet Ziya Özüer
- Department of Otorhinolaryngology, Izmir Teaching and Research Hospital and CI Center, Izmir, Turkey
| | - Levent Olgun
- Department of Otorhinolaryngology, Izmir Teaching and Research Hospital and CI Center, Izmir, Turkey
| | - Gürol Gültekin
- Department of Otorhinolaryngology, Izmir Teaching and Research Hospital and CI Center, Izmir, Turkey
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Persistent and recurrent conductive deafness following stapedotomy. The Journal of Laryngology & Otology 2010; 125:460-6. [DOI: 10.1017/s0022215110002422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractBackground:Stapedotomy produces the best hearing results of any otological operation. However, in a small number of cases the air–bone gap is not successfully closed, or conductive hearing loss recurs.Objective:To investigate the proportion of cases in the senior author's series which required revision surgery and to determine the medium to long term success rate of surgery, taking into account the results of revision surgery.Methods:Review of a series of 233 primary stapedotomy operations and 100 revision procedures carried out by one surgeon over a 20-year period.Results:Closure of the air–bone gap to within 10 dB was achieved in 80 per cent of cases following the primary procedure. Fifteen per cent of patients developed a recurrence of conductive hearing loss. When the results of revision surgery were taken into account, the proportion of ears with a mean air–bone gap of less than 10 dB was 86 per cent. However, of the patients undergoing revision surgery, air–bone gap closure to within 10 dB was only achieved in 52 per cent of cases.Conclusion:The best chance of obtaining a successful outcome in stapedotomy is to achieve this for the first procedure. However, revision surgery does increase the medium to long term success rate.
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Sarac S, McKenna MJ, Mikulec AA, Rauch SD, Nadol JB, Merchant SN. Results after revision stapedectomy with malleus grip prosthesis. Ann Otol Rhinol Laryngol 2006; 115:317-22. [PMID: 16676830 PMCID: PMC2758426 DOI: 10.1177/000348940611500412] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Revision stapedectomy with a malleus grip prosthesis is a technically challenging otologic procedure. The prosthesis is usually longer and extends deeper into the vestibule than a conventional stapes prosthesis, creating the potential to affect the vestibular sense organs. The prosthesis also bypasses the ossicular joints, which are thought to play a role in protecting the inner ear from large changes in static pressure within the middle ear. The prosthesis is in close proximity to the tympanic membrane, thus increasing the risk for its extrusion. We reviewed our experience with revision stapedectomy with the Schuknecht Teflon-wire malleus grip prosthesis in 36 ears with a mean follow-up of 23 months. The air-bone gap was closed to within 10 dB in 16 ears (44%) and to within 20 dB in 26 ears (72%). The incidence of postoperative sensorineural hearing loss was 8% (3 ears). There were no dead ears. Extrusion of the prosthesis occurred in 1 case (3%). Nearly 50% of patients reported various degrees of vertigo or disequilibrium during the first 3 weeks after surgery. These vestibular symptoms resolved by 6 weeks in all but 1 case. We did not find evidence of damage to the inner ear due to the length of the prosthesis or due to the potential for direct transmission of changes in static pressures within the middle ear to the labyrinth. Our results are similar to those published in the literature for malleus attachment stapedectomy and conventional revision incus stapedectomy.
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Affiliation(s)
- Sarp Sarac
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA
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