Pearls on the presentation and diagnosis of otosclerosis

February 1, 2008     William H. Lippy, MD and Leonard P. Berenholz, MD


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.

Myringostapediopexy after tympanomastoidectomy

August 31, 2007     Matthew Taljebini, MD; Eric P. Wilkinson, MD; Jose N. Fayad, MD

A 53-year-old man presented with chronic otitis media in the right ear and a cholesteatoma in the right ear. Audiometric testing revealed a high-frequency sensorineural hearing loss in both ears and a mixed hearing loss in the right ear.

Poststapedectomy reparative granuloma

August 31, 2006     Willis S.S. Tsang, FRCS (ORL); John K.S. Woo, FRCS (ORL); Michael C.F. Tong, MD

Oval window fistula

April 1, 2006     Arun Gadre, MD

Poststapedectomy hearing gain: Comparison of a Teflon (fluoroplastic ASTM F 754) prosthesis with a Schuknecht-type wire/Teflon prosthesis

November 1, 2005     Emilia Guadalupe Zepeda-López, MS; Antonio Bello-Mora, MS; Manuel Martín Félix-Trujillo, MS, MD
We conducted a retrospective study to compare poststapedectomy hearing gain in study-eligible patients who had received a Teflon (fluoroplastic ASTM F 754) prosthesis (study group; n = 76) with hearing gain achieved in a matched group (by age, sex, and degree of hypoacusis) of patients who had received a Schuknecht-type wire/Teflon prosthesis (control group; n = 70). All procedures had been performed by the authors at our institution between Jan. 2, 1994, and Dec. 31, 1997. Airway averages at low, medium, and high frequencies were estimated on the basis of pre- and postoperative audiologic evaluations, as were total air-bone gaps at 7 frequencies between 125 and 8,000 Hz. We found that the study group achieved a significantly greater degree of hearing gain at 125 and 250 Hz and significantly better closure of the air-bone gap at 250, 500, 1,000, 2,000, and 4,000 Hz. The hearing outcomes among patients in the study group were excellent.

The future of stapes surgery

June 30, 2005    

The effect of stapedotomy on tinnitus in patients with otospongiosis

June 30, 2005     Adriana da Silva Lima, MD; Tanit Ganz Sanchez, MD, PhD; Renata Marcondes, MD; Ricardo Ferreira Bento, MD, PhD
Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients' annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student's t test and Fisher's exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.

Surgical-handling properties of the titanium prosthesis in ossiculoplasty

March 1, 2005     Marcus M. Maassen, MD; Hubert Löwenheim, MD; Markus Pfister, MD; Stephan Herberhold, MD; Jesus Rodriguez Jorge, MD; Ingo Baumann, MD; Andreas Nüsser, MD; Rainer Zimmermann, MD; Sibylle Brosch, MD; Hans P. Zenner, MD
Despite the wide variety of ossiculoplasty techniques that are available, success rates are limited. Current use indicates that surgeons prefer ceramic, autograft bone, and plastic pore prostheses. During the past decade, titanium prostheses have been used with great promise. Although their use is not widespread, satisfaction rates are high. An earlier study of ossiculoplasty showed that titanium prostheses were effective in reducing conductive hearing loss. To date, the surgical-handling attributes of titanium middle ear prostheses have not been assessed. We report the results of our survey of 32 otologic surgeons who used the open Tübingen titanium prosthesis for primary and revision ossiculoplasty during tympanoplasty in 400 patients at 12 academic and nonacademic otolaryngology clinics, most of them in Germany. Because the audiometric efficacy of titanium prostheses has been previously reported, our primary outcomes measures included ease of use with respect to the amount of time required to prepare the implants for placement and the surgeons' overall impression of the intraoperative handling characteristics of the implants, taking into consideration factors such as positioning, length adjustment, visibility, and the stability of the coupling. Surgeons also compared the properties of the titanium implant with those of gold, ceramic, and autograft implants that they had used in the past. Based on the results of 383 of the 400 ossiculoplasties, our survey revealed that the titanium implant was significantly superior to the others in all measured respects.

Ossiculoplasty in a patient with a cleft of the soft palate

February 1, 2005     Arun K. Gadre, MD
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