August 10, 2012 Hadi Samimi-Ardestani, MD; Mohammadtaghi Khorsandi-Ashtiani, MD; Elmira Ghoujeghi, MD; Mohsen Rajati, MD; Mahtab Rabbani-Anari, MD; Aman Ghoujeghi, MD
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Abstract
During surgical treatment of a patient with otosclerosis, the probability of success depends in large part on the extent of the surgeon’s experience. Therefore, predicting the preoperative severity of disease may help determine the choice of surgeon based on how experienced the surgeon should be. We conducted a study to evaluate the relationship between hearing thresholds and footplate thickness in otosclerosis patients who underwent stapes surgery. We used a qualitative method for measuring footplate thickness that was based on the simplicity or difficulty of opening the footplate. Our study population was divided into two groups; group 1 was made up of 66 patients whose footplates were easily opened with low pressure or with repeated motions by hand, and group 2 was made up of 14 patients whose footplate was either opened by drilling or not opened because it had been obliterated. We found that the patients in group 2, who had more severe disease, had significantly higher air- and bone-conduction thresholds than did the patients in group 1. According to our findings, otosclerotic patients with high air- and bone-conduction thresholds generally have more severe disease and thus require a more experienced surgeon.
August 15, 2011 Stephen J. Wetmore, MD and Andrew F.L. Gross, MD
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Abstract
We conducted a retrospective chart review at a university hospital on a family that exhibited a rare cause of conductive hearing loss. Four male patients of this family had congenital conductive hearing loss. Three of these family members underwent bilateral ossiculoplasty, a father and two of his three sons. All three were found to have mild or moderate conductive hearing loss due to fixation of the head of the stapes by a bony bar that extended from the head of the stapes to the posterior ear canal wall. Surgical removal of the bony bar improved hearing in all cases. This family exhibits autosomal-dominant inheritance of this abnormality. Fixation of the head of the stapes by a bony bar that extends to the posterior ear canal wall is a rare cause of congenital, autosomal-dominant, mild or moderate conductive hearing loss that can be surgically corrected.
April 30, 2011 Li-Ser Khoo, FRCR and Tiong-Yong Tan, FRCR
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Abstract
A penetrating ear injury with a perilymphatic fistula is not an uncommon occurrence in otolaryngologic practice, but stapes luxation is rare. We report the case of an 11-year-old boy who developed a traumatic perilymphatic fistula secondary to an atypical stapes luxation into the vestibule. After sustaining a penetrating injury to the right ear, the patient presented with otalgia, vertigo, vomiting, gait unsteadiness, and hearing loss. High-resolution computed tomography (HRCT) of the temporal bone detected pneumolabyrinth, indicating a perilymphatic fistula. The stapes had pivoted on the footplate at the oval window, and then it made an unusual 180° flip and luxated deeply into the vestibule, with the capitulum stapedis pointing medially. Conservative management was chosen in view of the high surgical risks posed by the deeply luxated stapes and the likelihood of a fracture of the stapes footplate. This case illustrates the importance of an accurate diagnosis and interpretation of a traumatic perilymphatic fistula and stapes luxation as seen on HRCT of the temporal bone.
December 17, 2010 Gediz Murat Serin, MD, Behram Çam, MD, Ufuk Derinsu, PhD, Murat Sari, MD, and Çağlar Batman, MD
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Abstract
In stapedotomy, augmentation of the long process of the incus is necessary when the structure is too short or thin or when the bone has been eroded to the point that it is not possible to satisfactorily attach a piston prosthesis to it. One substance that has been used to augment the long process is glass ionomer cement (GIC). GIC is a dental bone cement that is finding new uses in otologic procedures. We conducted a retrospective study of 10 stapedotomies (6 primary and 4 revision cases) that included the use GIC to augment an insufficient long process. In all 10 cases, surgery was successful and without complication. A comparison of pre- and postoperative audiometry revealed significant improvements in mean air-conduction threshold and air-bone gap following surgery. Our findings suggest that GIC is safe and effective in augmenting the long process of the incus during both primary and revision stapedotomy.
December 1, 2009 William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS
October 31, 2009 Vanessa S. Rothholtz, MD, MSc and Hamid R. Djalilian, MD
August 31, 2009 James Lin, MD and Jose N. Fayad, MD
July 31, 2009 William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS
March 31, 2009 Fred Linthicum Jr., MD
January 1, 2009 Eric P. Wilkinson, MD and John W. House, MD
December 1, 2008 William H. Lippy, MD, FACS and Leonard P. Berenholz, MD, FACS
February 1, 2008 William H. Lippy, MD and Leonard P. Berenholz, MD
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Abstract
Since the 1960s, our group has performed more than 18,000 primary and revision stapedectomies for the treatment of otosclerosis. All of the patient histories, surgical findings, and hearing results pertinent to these cases have been entered into a database at our clinic. The suggestions and conclusions that we offer in this and in future installments of Clinical Nuggets are based on, and thus validated by, the experience that has been documented in our database. We begin with some pearls on the presentation and diagnosis of otosclerosis. In future installments, we will provide some tips on the physical examination and on primary and revision stapedectomy. Our goal is to give you a clear picture of what works and what doesn't.
