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Otosclerosis
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
Stapedectomy was first described by John Shea in 1956. This involves removing the fixed stapes and placing a piston from the incus to the vestibule. The basic technique Shea described remains in place. However, refinements have taken place over the last 60 years, and the main modification of the technique is to perform a small stapedotomy rather than removing the whole stapes footplate. This has reduced the risk of total sensory hearing loss and probably improved high-frequency hearing results. There are many piston designs but with little to choose between them. A larger piston diameter should theoretically give better hearing, but the differences are small. Most surgeons use a piston with a diameter between 0.4 and 0.6 mm. There are a variety of methods of removing the stapes superstructure and performing the stapedotomy. Cutting the stapes crura with a laser reduces the risk of stapes dislocation when removing the superstructure. Many surgeons use a laser when performing the stapedotomy, but there is no good evidence to favour laser over microdrill or hand trephine. If the incus is eroded the piston can be secured using bone cement. If the residual incus long process is very short or dislocated a malleostapediopexy can be performed in which a piston is placed from the malleus handle to the stapedotomy. Whilst not as good as standard stapedotomy, excellent results can still be achieved with this technique.
Noise, hearing and vibration
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Middle ear: Ossicles – small bones behind eardrum (malleus, incus and stapes).Eardrum – transmits vibrations via ossicles through middle ear to inner ear.Eustachian tube – connects middle ear to posterior oropharynx for pressure equalization.
Deafness and hearing loss
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
The middle ear is a cavity approximately one to two cubic centimeters in volume that is connected to the nasopharynx by the eustachian tube. A dysfunction of the eustachian tube will affect hearing as well as result in enlarged adenoids, allergic congestion, and colds. Most middle-ear infections begin in the eustachian tube, resulting in unequal pressure on either side of the tympanic membrane that interferes with the vibration of sound waves and results in a conductive hearing loss. The middle ear contains three bones (incus, malleus, and stapes) that connect the tympanic membrane to the entrance of the inner ear (oval window). The bones transmit sound waves across the ossicular chain, with the last bone (stapes) being implanted in the oval window.
On the battery life of a totally implantable active middle ear device: a retrospective study in a single implanting center
Published in Acta Oto-Laryngologica, 2023
Maurizio Barbara, Valerio Margani, Luigi Volpini, Chiara Filippi, Edoardo Covelli, Simonetta Monini, Haitham H. Elfarargy
When comparing the post-implantation BC thresholds with the pre-implantation ones, hearing deterioration prevailed in the group with three battery changes. These data follow the observation by Shohet et al. who found an increase in the BC thresholds by 3.7 dB [14]. Also, Barbara et al. found a delayed deterioration of bone conduction in the operated ear and the contralateral one to a minor degree [15]. At present, it is difficult to explain this finding. However, it is possible to rule out the role of the etiology of deafness since, in bilateral symmetric cases, the implanted ear displayed a much worse deterioration than the contralateral one [11]. The other factor to be taken into account is the role of direct vibratory stimulation on the stapes with eventual inner ear effects. In this regard, it is known that, contrary to electromagnetic devices, piezoelectric systems may deliver powerful energy with minimal consumption, the main reason for selecting them for fully-implantable devices [16].
Relationship between short-term and mid-term hearing outcomes after stapedotomy in patients with otosclerosis: an investigation
Published in Acta Oto-Laryngologica, 2021
Yanqing Fang, Ke-guang Chen, Yu Zhao, Nikita A. Menon, Austin J. Scholp, Yilai Shu, Bing Chen
Stapedotomy is an effective method for the treatment of clinical otosclerosis. However, functional outcomes of stapes surgery depend on various factors. These factors mainly include surgeons’ experience [1], the design of the artificial stapes prosthesis that is implanted (diameter, material, etc.)[2,3], types of techniques used [4], preoperative hearing threshold of patients [5], and even the follow-up time of pure tone audiometry tests after the operation [6,7]. Some researchers have found that the success rate of stapes surgery improves over time [4,5], whereas the time of hearing stabilization has not yet been consistent. In Dhooge et al.’s report, hearing outcomes were similar between 1 month and long term follow-up of more than a year [8]; however, Andersen et al. reported that hearing outcomes after stapedotomy could not reach stability until 3 months post-operation [9]. Evaluation of functional outcomes after stapes surgery has usually been carried out around the third or fourth week post-operation, which is believed to coincide with the healing process for both the middle and inner ear [10]. With longer follow-up times, subject attrition increased [9,11]. Thus, to what extent do the auditory outcomes measured within the first month following stapedotomy reflect those evaluated at a relatively stable time? Answering this question could increase short-term postoperative doctor-patient communication and patients’ confidence in prognosis of hearing function.
The effect of using a PORP to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle
Published in Acta Oto-Laryngologica, 2021
Min Zhang, Xiaoyun Chen, Yideng Huang, Zifei Yang, Yue Zhang, Xianmin Wu
Nevertheless, there are many factors that affect postoperative hearing gain [9–11], including the type of surgical procedure, the presence of a residual ossicular chain, and the type of prosthesis. In this study, all patients underwent OCR with PORPs under otoendoscopy. It is generally believed that the presence of the stapes superstructure is crucial for optimizing hearing results after ossiculoplasty. However, the effect of the presence of the malleus handle on ossiculoplasty is debatable. Previous studies have shown that the presence of a malleus is a significant predictor of surgical success [12]. Someone showed that a prosthesis with malleus assembly to the stapes head had a better hearing effect than that with TM assembly to the stapes head [13]. In contrast, Haberman and Salapatas [14] concluded that malleus removal had comparably favorable results to preservation of the malleus during OCR. Shimizu and Goode [15] found that the absence of a malleus handle caused slight damage to sound transmission in the intermediate frequency and improved sound transmission in the high frequency compared with preservation of the malleus handle. Nevertheless, there was no statistically significant difference.