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Stapes Surgery (stapes + surgery)
Selected AbstractsThe Learning Curve in Stapes Surgery and Its Implication to TrainingTHE LARYNGOSCOPE, Issue 1 2006FRCS, M. W. Yung PhD Objective: To identify the stapedotomy learning curve of two U.K. otolaryngologists. Study Design: A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. Setting: Two tertiary referral centers. Patients: All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. Intervention: One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. Main Outcome Measures: A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of ,success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. Results: There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. Conclusions: The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist. [source] Eliminating the Limitations of Manual Crimping in Stapes Surgery?THE LARYNGOSCOPE, Issue 2 2005A Preliminary Trial with the Shape Memory Nitinol Stapes Piston Abstract Objective: Manual piston malcrimping in stapedotomy may be the major cause of the occurrence of the significant, interindividual variations of postoperative air-bone gap (ABG), air-bone gap closures (ABGC), and postoperative recurrences of conductive hearing loss. To eliminate the effects of manual crimping on stapedotomy outcomes, the self-crimping, shape memory alloy Nitinol stapes piston was investigated and hearing evaluated. Study design: Prospective, preliminary case-control study in a tertiary care referral center. Methods: Sixteen patients with otosclerosis undergoing reversed stapedotomy using the Nitinol stapes piston were matched to reference patients out of our conventional titanium piston database. The effects of the self-crimping Nitinol piston on the postoperative ABGC, the postoperative air-bone gap (ABG) variations, and the postoperative short-term hearing results were investigated 3, 6 and 9 months postoperatively. These data were statistically compared with the results of the control patients in our titanium stapes piston database. Results: The mean postoperative ABG and the interindividual variations of the postoperative ABG were significantly smaller in the Nitinol group, the extent of ABGC greater in the Nitinol piston group, but not significant. The postoperative short-term stability of ABGC was similar in both groups. No infections or adverse reactions occurred during follow-up. Conclusion: Our preliminary results suggest that the self-crimping shape memory alloy Nitinol stapes piston eliminates the limitations of manual malcrimping in stapedotomy, thus optimising the surgical procedure. This allows reliable, safe, and consistent air-bone-gap closure in patients with otosclerosis up to 1 year after surgery. [source] Necrosis of the long process of the incus following stapes surgery: New anatomical observations,,THE LARYNGOSCOPE, Issue 4 2009Imre Gerlinger MD Abstract Objectives/Hypothesis: The most frequent complication (generally recognized during revision procedures) following seemingly successful stapedotomies and stapedectomies is necrosis of the long process of the incus. This is currently ascribed to a malcrimped stapes prosthesis or to a compromised blood supply of the incus. The two-point fixation can cause a mucosal injury with a resulting toxic reaction, and also osteoclastic activity. An important aspect in the engineering of ideal stapes prostheses is that they should be fixed circularly to the long process of the incus with appropriate strength. The objective of this study was to compare current knowledge relating to the blood supply of the ossicular chain with the present authors' observations on cadaver incudes. Most of the papers dealing with this issue appeared in the mid-20th century. Methods: The published data were compared with the authors' findings gained from photodocumentation on 100 cadaver incudes. The photos were taken with a Canon EOS 20 digital camera (Canon, Inc., Lake Success, NY) with a 5:1 macro-objective. The long processes of the incudes were examined from four directions under a Leica surface-analyzing microscope (Leica Microsystems GmbH, Wetzlar, Germany). Results: Analysis of the positions of the entrances of the feeding arteries (nutritive foramina) on the incudes revealed 1-4 nutritive foramina on the long processes of 48% (24) of the left-sided incudes and 56% (28) of the right-sided incudes. The positions of these foramina differed, however, from those previously described in the literature. They were mostly located not on the medial side of the incus body or on the short process or on the cranial third of the long processes, but antero-medially, mostly on the middle or cranial third. In 48% of all the incudes examined, an obvious foramen was not observed either in the body or in the long process of the incus. No relationship was discerned between the chronological age of the incus specimens and the numbers and/or locations of the nutritive foramina. In each case, the opening of the foramen was the beginning of a tunnel running obliquely and medially upward through the corticalis of the long process of the incus. The foramina are thought to be capable of ensuring a richer blood supply between the surface and the inside of the long process, allowing the arteries to run in and out. Conclusions: These observations indicate that conclusions drawn from classical anatomical works appear to need reconsideration. The present authors consider that the reason for the necrosis of the long process of the incus is not a compromised blood supply, except in some exceptional anatomical situations. They discuss the possible reasons why malcrimping may lead to necrosis of the long process of the incus. To prevent such malcrimping, attention is paid to the new generation of prostheses. Laryngoscope, 2009 [source] The Learning Curve in Stapes Surgery and Its Implication to TrainingTHE LARYNGOSCOPE, Issue 1 2006FRCS, M. W. Yung PhD Objective: To identify the stapedotomy learning curve of two U.K. otolaryngologists. Study Design: A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. Setting: Two tertiary referral centers. Patients: All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. Intervention: One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. Main Outcome Measures: A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of ,success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. Results: There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. Conclusions: The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist. [source] Phenotype and genotype in females with POU3F4 mutationsCLINICAL GENETICS, Issue 6 2009S Marlin X-linked deafness is a rare cause of hereditary isolated hearing impairment estimated as at least 1% or 2% of the non-syndromic hearing loss. To date, four loci for DFN have been identified and only one gene, POU3F4 responsible for DFN3, has been cloned. In males, DFN3 is characterized by a progressive deafness associated with perilymphatic gusher at stapes surgery and with a characteristic inner ear malformation. The phenotype of eight independent females carrying POU3F4 anomalies is defined, and a late-onset hearing loss is found in three patients. Only one has an inner ear malformation. No genotype/phenotype correlation is identified. [source] A retrospective review of stapes surgery following introduction of ,reversal of the steps' techniqueCLINICAL OTOLARYNGOLOGY, Issue 6 2004E.E. Lang A retrospective study of 73 consecutive stapedotomies is reported. The technique of reversal of steps was achieved in 59% of cases. Closure of the air,bone gap to within 10 dB was achieved in 84% of the reversal group, and 81% of the standard technique group, with no statistically significant difference between the two groups. [source] Audit of stapedectomy results in a district general hospitalCLINICAL OTOLARYNGOLOGY, Issue 4 2002A. Banerjee We report a series of 100 stapes operations performed for otosclerosis. The problems in reporting the results of stapedectomies are discussed. The audit showed a difference in the measured results between two consultants. As a result, the consultant with the worse outcome chose to stop operating on patients with otosclerosis. The advantages and disadvantages of a single surgeon performing all the cases are discussed. We advocate a central registry of all surgeons performing stapes surgery to allow periodic national comparative audits. [source] A study of the intra-operative effect of the Argon and KTP laser in stapes surgeryCLINICAL OTOLARYNGOLOGY, Issue 4 2002M.W. Yung The intraoperative effect of the Argon and KTP laser was studied on 20 patients who had primary stapes surgery under local anaesthetic; 10 had Argon and 10 had KTP laser stapedotomy. Symptoms of inner ear disturbance such as dizziness and tinnitus were systematically recorded during the laser procedure. Both dizziness and tinnitus were relatively uncommon when the laser was used on the promontory. When the laser was used to transect the posterior crus, all the patients reported transient dizziness, probably from the thermal effect through the posterior crus into the inner ear. However, tinnitus was unusual during this stage. When the laser was used to fenestrate the footplate, only 30% of patients reported a transient dizziness as less laser energy was used. On the other hand, 55% of the patients experienced tinnitus during this stage, which indicates an acoustic effect on the inner ear. There is no difference between the Argon and KTP laser. [source] | ||||||||||