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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Stapes surgery, commonly known as ‘stapedectomy’ is a treatment for otosclerosis and any other cause of stapes fixation. The middle ear is entered by lifting the tympanic membrane. The bony scutum may then be widened for greater access, aiming to preserve the chorda tympani which lie in the same plane. After confirmation of stapes fixation by testing ossicular chain mobility, then incudostapedial joint is divided. The stapedius tendon is then divided, followed by the posterior crus of the stapes suprastructure. The stapes suprastructure is then downfractured and removed. A hole is then made in the stapes footplate. Typically this might measure 0.4–0.6mm. Prosthesis is placed onto the long process of incus and passes through the footplate fenestration. This then restores the conduction of sound from the tympanic membrane all the way through to the inner ear. Risks to explain in the consent process include: dead ear, worsening or failure to improve hearing, infection, bleeding, dizziness, tinnitus, altered taste, facial palsy, perilymph leak, prosthesis failure and tympanic membrane perforation.
Ossiculoplasty and Myringoplasty
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Acquired: Secondary to chronic suppurative otitis media Erosion incudostapedial joint (ISJ) More commonLong process of incusStapes superstructureMalleus Less common
Chronic Otitis Media
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
George G. Browning, Justin Weir, Gerard Kelly, Iain R.C. Swan
Is this retraction pocket thought to be self-cleansing or not? What is the relationship of the tympanic membrane to the incudostapedial joint? Is there partial or complete erosion? What effect has this had upon hearing thresholds? Has the bony ear canal at the level of the tympanic membrane been eroded by long-standing retraction of the pars tensa and become wider? This can be evaluated because structures not normally visible, such as the stapedius tendon and facial nerve, becoming visible. Is the pars tensa adherent to the promontory or not? Whether or not the tympanic membrane is adherent to the promontory may be difficult to evaluate, but Charachon189 and Gersdorff and Garin190 argued that autoinflation may provide evidence of such adherence.
Comparison between incus short process and long process coupling of the vibrant soundbridge in human temporal bones
Published in International Journal of Audiology, 2023
Lukas Graf, Jonas Lochner, Hamidreza Mojallal, Andreas Arnold, Flurin Honegger, Christof Stieger
Assuming that the device is perfectly connected, the main difference between the two couplers is the distance of the vibrating FMT to the rotational axis of the whole ossicular chain. Given that the FMT always produces the same force for a constant excitation, with a greater lever arm, the LP coupler produces more torque, which is especially effective at low frequencies. Nevertheless, a placement of the LP coupler close to the incudostapedial joint is more favourable as documented in the clinical study of Lee et al. (2017). An even longer distance will increase the torque but might reduce the vibration transferred to the stapes. In contrast to Lee et al., at low frequencies, our experimental findings show higher magnitudes for the LP coupling. This would be consistent with the theory of low efficiency of the FMT in low frequencies due to its floating mass that requires a higher torque to move the ossicular chain. In middle and high frequencies a FMT placement even closer (and opposite) to the ossicular chain axis like in SP coupling is more efficient because less torque seems to be required. However, to answer these questions in detail, a modelling analysis including impedances, rotation axes of the middle ear and FMT coupling parameters would be needed.
A new phenomenon of cochlear otosclerosis: an acquired or congenital disease? – A clinical report of cochlear otosclerosis
Published in Acta Oto-Laryngologica, 2021
Simeng Lu, Xingmei Wei, Biao Chen, Jingyuan Chen, Lifang Zhang, Mengge Yang, Zhiming Sun, Ying Shi, Ying Kong, Sha Liu, Yongxin Li
All patients underwent CI surgery using a standard transmastoid-facial recess approach. The surgical procedure was performed as follows. After mastoidectomy, the posterior tympanum from the facial recess was opened, and the round window (RW) niche was revealed. Palpation of the ossicles was performed to confirm whether the stapes was mobile. The RW niche was usually not well visualized due to ossification in that region. The position of the incudostapedial joint and stapes was used as the landmark for locating the RW. The stylet in situ was first inserted to confirm a relatively patent scala tympani through the RW. The electrode array was then implanted. Neural response telemetry (NRT) was performed during surgery. Both postoperative X-ray and CT scans were used to confirm proper positioning of the electrode array 4 d after surgery. The implants were activated 4 weeks postoperatively. All channels were tested during implant mapping.
Surgical treatment of otosclerosis using a unique stapes prosthesis without a hook
Published in Acta Oto-Laryngologica, 2021
Sho Kanzaki, J. Kanzaki, K. Ogawa
The first author, an experienced surgeon, performed all of the operations in this series. Our general stapedectomy/stapedotomy techniques are as follows. First, a local anaesthetic agent is injected into the 4-quadrant canal. We make a permeatal incision, elevate the tympanic membrane and confirm stapes fixation. If the stapes footplate is mobile, we do not perform stapedectomy. In most cases, we perform a surgical mobilization of the stapes or tympanoplasty. A curette is used to remove part of the scutum to visualize the pyramidal process and facial nerve. After separating the incudostapedial joint, the stapedial tendon and posterior crura of the stapes are drilled using a skeeter drill. The stapes is then down-fractured. A stapedotomy is made in the centre of the footplate using a skeeter drill. The fenestration size is 1.0–1.2 mm to avoid a bony overgrowth of the oval window (Figure 2). Next, we place perichondrium from the tragus cartilage over the opening window of the stapes and insert the stapes prosthesis over this perichondrial tissue. We touch the prothesis and check the round window reflex to confirm the mobility of the prosthesis. Finally, we place gel foam and fibrin glue around the prosthesis to avoid slippage of the perichondrium. The tympanomeatal flap is then returned to its normal position.