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Cohen-Vaizer M, Dreyfuss M, Na'ara S, Shinnawi S, Laske R. The Impact of Surgical Expertise on the Cost-Effectiveness of Stapes Surgery. Audiol Neurootol 2023; 28:436-445. [PMID: 37343529 DOI: 10.1159/000530783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Otosclerosis is the primary cause of conductive hearing loss with normal otoscopy. As the condition worsens, certain patients may develop a sensorineural component. Patients with successful surgeries may still need hearing aids, which creates a dilemma for health professionals as there are insufficient data to make informed decisions. This study investigated the influence of the surgeon's proficiency level, individual patient factors (e.g., age at the time of intervention and survival rates), and surgery costs on the cost-effectiveness of stapes surgery. METHODS We performed a cost-effectiveness analysis using an adapted Markov model incorporating annual all-cause mortalities. In addition, we introduced sensitivity analyses to address the effects of surgical expertise on adults with bilateral conductive hearing loss due to otosclerosis. A model was developed based on a decision tree with treatment options and complication scenarios for otosclerosis patients undergoing stapes surgery or receiving hearing aids. Annual all-cause mortality was considered. A sensitivity analysis was performed assigned to different training levels ("experts" and "less experienced") to simulate the effects of surgical experience on the cost-effectiveness of surgical outcomes. Successful surgery was defined as closing of the air-bone gap to 10 dB or less. Based on published data, "experts" were simulated with a 93.7% success rate, and "less experienced" were manufactured with a 68.9% success rate. RESULTS Stapes surgery provides improved quality of life (QoL) compared to hearing aids with lower cumulative costs up to 87 years of age in the case of "expert" surgeons and up to 78 years of age, when performed by "less experienced" surgeons. CONCLUSIONS Primary stapes surgery is highly cost-effective and delivers improved QoL compared to hearing aids with lower cumulative costs. Additionally, undergoing stapes surgical training remains highly cost-effective.
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Affiliation(s)
- Mauricio Cohen-Vaizer
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Michael Dreyfuss
- Department of Industrial Engineering and Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Shoorok Na'ara
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
- Department of Otolaryngology, Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA
| | - Shadi Shinnawi
- Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Roman Laske
- Department of Otolaryngology, HNO Wiedikon, Zurich, Switzerland
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Mariani C, Carta F, Piras N, Marrosu V, Serra F, De Seta D, Puxeddu R. Evaluation of Audiological Results and Cochleo-Vestibular Subclinical Injury After CO 2 Laser Stapedotomy. Lasers Surg Med 2021; 53:1186-1191. [PMID: 34004037 DOI: 10.1002/lsm.23416] [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: 12/19/2020] [Revised: 03/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Evaluation of the effectiveness and safety of CO2 laser stapedotomy, focusing on the audiological results, and on the surgical cochleo-vestibular trauma. STUDY DESIGN/MATERIALS AND METHODS Retrospective clinical trial on 38 patients with the diagnosis of otosclerosis, who underwent CO2 laser stapedotomy between January 2015 and October 2019. Postoperative air-bone gap (ABG), mean air conduction gain, and postoperative changes of high frequency threshold were evaluated 1, 3, 6, and 12 months after surgery. Videoculography (VOG) was performed to assess the vestibular impairment preoperatively and 1 day, 1 week, and 1 month after surgery. RESULTS Postoperative ABG closure within 10 dB was obtained in 35 cases (92.1%), with a mean postoperative ABG of 4.4 dB and a mean air conduction improvement of 32.3 dB. No significant worsening of high frequency threshold was observed. Spontaneous nystagmus was found preoperatively in 5/38 patients (13.2%), 1 day after surgery in 13/38 patients (34.2%), 1 week after surgery in 12/38 patients (31.6%), and 1 month after surgery in 4/38 patients (10.5%). Positional nystagmus was found preoperatively in 12/38 patients (31.6%), 1 day after surgery in 25/38 patients (65.8%), 1 week after surgery in 22/38 patients (57.9%), and 1 month after surgery in 10/38 patients (26.3%). The occurrence of nystagmus did not always correlate with vestibular symptoms: after surgery, 10 patients (26.3%) experienced vertigo associated with dizziness, 8 patients (21.1%) suffered from dizziness without vertigo, and 14 patients (36.8%) showed nystagmus without any symptomatology. At 1 month after surgery none of the patients complained about vestibular symptoms. CONCLUSION CO2 laser stapedotomy is a safe and effective technique, which allows to obtain good functional results with minimal perioperative cochleo-vestibular trauma.© 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Nicoletta Piras
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Federica Serra
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Daniele De Seta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
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Fernandez IJ, Bonali M, Yacoub A, Ghirelli M, Fermi M, Presutti L, Caversaccio M, Anschuetz L. Training model for salvage procedures in endoscopic stapes surgery. Eur Arch Otorhinolaryngol 2020; 278:987-995. [PMID: 32592010 DOI: 10.1007/s00405-020-06166-6] [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: 03/11/2020] [Accepted: 06/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The learning curve in endoscopic stapes surgery, is flat and long. There is limited space during training for advanced and salvage procedures, which could be necessary in unexpected intraoperative scenarios. The aim of the present study is to develop an ex-vivo animal model for training in salvage and advanced procedures in endoscopic stapes surgery METHODS: After defining the difficult intraoperative scenarios requiring a salvage procedure during stapes surgery, we used the ovine model to create those intraoperative situations. After assessing the suitability of the model for that purpose, it was validated by subjective feedback rating (scale from 1 to 10) and by comparing the relevant anatomical structures for stapes surgery with the human. Finally, an optimal sequence of surgical steps was defined. RESULTS 8 Fresh frozen lamb heads (16 ears) were studied. The selected intraoperative scenarios were: floating footplate, footplate fracture, luxation of the incus or necrosis of the long process, overhanging facial nerve, obliterative otosclerosis. The simulation resulted feasible and close to real. The mean overall rating for surgical scenarios ranged from 7.5 to 8.8 for residents and was consistent with the rating of senior surgeons, ranging from 7.67 and 9.0. Anatomical measures of the oval window area resulted similar between the ovine and the human. CONCLUSION The ex-vivo ovine model is a suitable model for training in salvage and advanced procedures in exclusively endoscopic stapes surgery. The model can be used both for the training and maintenance of the acquired advanced skills in endoscopic stapes surgery.
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Affiliation(s)
- Ignacio Javier Fernandez
- Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy.
| | - Marco Bonali
- Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy
| | - Abraam Yacoub
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Michael Ghirelli
- Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy
| | - Matteo Fermi
- Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy
| | - Livio Presutti
- Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy
| | - Marco Caversaccio
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Quaranta N, Piccininni K, Romanello M, Lucidi D, Sergi B. The impact of intra-operative factors in otosclerosis outcomes: retrospective study in a tertiary centre. ACTA ACUST UNITED AC 2019; 39:197-204. [PMID: 31131839 PMCID: PMC6536026 DOI: 10.14639/0392-100x-2004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/23/2018] [Indexed: 11/23/2022]
Abstract
The aim of the study was to assess results from a large cohort of patients undergoing otosclerosis surgery with respect to the impact of intra-operative variables on post-operative hearing function and complications. We enrolled 384 patients affected by otosclerosis who were subjected to stapes surgery between 2004 and 2013 at a single institution. Surgery was performed in all cases under local anaesthesia, using a manual perforator and/or microdrill. Teflon-piston prosthesis was used in all patients. Audiological data obtained preoperatively and at last follow-up examination (minimum 12 months) were compared. Statistical analysis was performed using the multiple regression model. Peripheral rim otosclerosis and diffuse otosclerosis were associated with better functional results compared to the obliterative pattern (p < 0.05). Mean post-operative Air-Bone Gap was significantly higher in the 0.4 mm, compared to 0.6 mm piston group at 0.5 kHz (p < 0.001) and 1 kHz (p < 0.02); in the stapedotomy group a statistically significant difference was found between 0.4 and 0.6 mm piston groups, in favour of the latter (p < 0.05). No differences were encountered in terms of average hearing threshold and complications. Intra-operative variables cannot be fully predictable and our data could help in stratification of the results and as a landmark for the surgeon’s decisions.
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Affiliation(s)
- N Quaranta
- UOC Otorinolaringoiatria Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy
| | - K Piccininni
- UOC Otorinolaringoiatria Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy
| | - M Romanello
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Lucidi
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Sergi
- UOC Otorinolaringoiatria, Fondazione Policlinico A. Gemelli-IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
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Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching. Eur Arch Otorhinolaryngol 2017; 274:2733-2739. [DOI: 10.1007/s00405-017-4572-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Sergi B, Lucidi D, De Corso E, Paludetti G. Long-term follow-up after "one-shot" CO 2 laser stapedotomy: is the functional outcome stable during the years? Eur Arch Otorhinolaryngol 2016; 273:3623-3629. [PMID: 27007130 DOI: 10.1007/s00405-016-3976-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Abstract
The use of "one-shot" CO2 laser technique for a primary small-fenestra stapedotomy is well established, but few papers report the long-term functional results. We retrospectively reviewed medical records of 198 patients, treated for otosclerosis from January 2008 to December 2011, at the Department of Head and Neck Surgery, Catholic University of Rome. Statistical comparison between audiological thresholds obtained 24 h preoperatively, at early (4 weeks) and late postoperative examinations (mean time 45 months), was performed. Comparison of preoperative vs both early and late postoperative ACPTA showed a statistically significant difference (respectively 55 vs 33 and 31 dB; p < 0.001). No statistical difference was observed between preoperative, early and late postoperative BCPTA (respectively 23 vs 23 and 22 dB; p > 0.05). Both early and late postoperative ABG improved significantly compared to the preoperative one (respectively 10 and 9 vs 32 dB; p < 0.001). No statistical difference was found in comparison of early vs late postoperative ACPTA (respectively 33 vs 31 dB; p > 0.05), early vs late postoperative ABG (respectively 10 vs 9 dB; p > 0.05) and early vs late ABG gain (respectively 22 vs 23 dB; p > 0.05). No subjects developed postoperative complications requiring revision surgery or late deterioration of hearing threshold. The analysis of our data suggests that "one-shot" CO2 laser stapedotomy is an effective and safe procedure: it allows a rapid stapedotomy without damages for the inner ear and optimal functional results that remain stable during the years.
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Affiliation(s)
- Bruno Sergi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy.
| | - Daniela Lucidi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
| | - Eugenio De Corso
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
| | - Gaetano Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, "A. Gemelli" Hospital, Largo A. Gemelli n.1, 00168, Rome, Italy
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