RESUMEN

A new category of hearing technology has emerged that comprises devices inserted deep into the ear canal. Although not implanted, they represent an extension of what is expected of a traditional hearing aid. There are advantages to these devices, but they are not suited for all individuals with hearing loss. This category consists of 2 devices currently available in the United States: Lyric (Phonak AG, Stafa, Switzerland) and Earlens (Earlens, Menlo Park, CA, USA).

Asunto(s)

Audífonos/clasificación , Pérdida Auditiva Sensorineural/rehabilitación , Umbral Auditivo/fisiología , Pruebas Auditivas , Humanos , Satisfacción del Paciente , Diseño de Prótesis , Ajuste de Prótesis , Percepción del Habla/fisiología

RESUMEN

OBJECTIVE: To compare 2 surgical techniques for implantation of a percutaneous bone anchored hearing device: (1) a minimal skin punch incision without additional skin incision or soft tissue reduction and (2) implantation with an epidermal flap and soft tissues reduction. STUDY DESIGN: Prospective study. SETTING: Tertiary care referral center. SUBJECTS AND METHODS: Forty patients consecutively implanted (18 males and 22 females). Twenty patients underwent implantation by means of epidermal flap and soft tissues reduction (dermatome group), and 20 patients underwent skin punch resection without soft tissues reduction (punch group). MAIN OUTCOME MEASUREMENTS: surgical adverse events, surgical time, skin healing, skin tolerance (Holgers classification), and skin appearance and implant failure. RESULTS: The surgical time was shorter with the punch technique (P < .05). The postoperative healing was satisfactory in both groups. All implants were loaded after the healing period. The skin tolerance was good in both groups by Holgers classification (punch, 85.7%/dermatome, 86%) with no significant difference. There were no severe adverse skin events in the punch group. The appearance of the skin around the implant was improved by the punch technique. CONCLUSION: The implantation of the currently available percutaneous bone anchored hearing implants with a minimal skin punch skin resection without additional skin incision or soft tissue reduction shortens the surgery and improves the postoperative appearance. The skin tolerance is at least as good as with techniques with that include soft tissue reduction.

Asunto(s)

Audífonos , Procedimientos Quirúrgicos Otológicos/métodos , Implantación de Prótesis/métodos , Anclas para Sutura , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Procedimientos Quirúrgicos Otológicos/efectos adversos , Estudios Prospectivos , Implantación de Prótesis/efectos adversos , Piel/fisiopatología , Cicatrización de Heridas , Adulto Joven

RESUMEN

OBJECTIVE: To measure early audiometric changes after primary stapedotomy. STUDY DESIGN: Case series with chart review. SETTING: Academic inner-city hospitals. SUBJECTS AND METHODS: Consecutive patients operated on by the first author were included (only 1 ear in cases of bilateral surgery), and their audiometric results were reviewed. Data were analyzed from 45 ears. Air and bone audiometric measures were analyzed from 5 days post operation and 6 months post operation. Threshold shifts were quantified at 5 days and 6 months post operation. RESULTS: Overall results for the group were good, with 91% of patients achieving an air-bone gap less than or equal to 10 dB by 6 months post operation. Threshold shifts in at least 1 frequency were common at 5 days (62% of patients), but less so at 6 months (36%). Patients with shifts did not have worse overall outcomes at 6 months than those with no shifts. No difference in results was observed for the 2 prostheses used in this series. CONCLUSION: Early audiometric results after stapedectomy commonly reveal worsened bone conduction (postoperative threshold shifts), which may reflect cochlear trauma, but do not lead to poorer outcomes as measured by conventional methods.

Asunto(s)

Audiometría de Tonos Puros , Conducción Ósea , Otosclerosis/fisiopatología , Otosclerosis/cirugía , Periodo Posoperatorio , Cirugía del Estribo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros/métodos , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cirugía del Estribo/métodos , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To evaluate with a new otologic database the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients operated on by the same surgeon with the same technique (stapedotomy and vein graft interposition) and to provide online access to the complete data of this study for the reviewers. To study the effect of specific operative findings (obliterative otosclerosis and simultaneous malleus ankylosis) and age at the time of surgery on the long-term outcome. STUDY DESIGN: Prospective clinical study using a new computerized otologic database. SETTING: : Tertiary referral center. PATIENTS: Two thousand five hundred twenty-five patients who underwent 3,050 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 1991 to December 2004. Separate analyses were made for two unique pathologies (92 cases of obliterative otosclerosis and 19 cases of simultaneous malleus ankylosis) diagnosed during surgery and for patients in two age brackets (or=65 yr [302 patients]). INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with either a Teflon piston, a bucket handle prosthesis, or a total prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds were all assessed. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months and then annually for 14 years. RESULTS: Overall, the postoperative ABG was closed to 10 dB in 94.2% of cases. The mean four-frequency postoperative ABG was 1.7 dB compared with 25.6 dB preoperatively. The mean four-frequency bone-conduction thresholds were unchanged postoperatively. A significant postoperative sensorineural hearing loss (SNHL; >15 dB) was seen in 0.5% of cases in this series. Postoperative ABG was achieved to within 10 dB in 95% of cases of obliterative otosclerosis and in 64.7% of cases of simultaneous malleus ankylosis. A significant postoperative SNHL (>15 dB) was seen in 4.8% of cases of obliterative otosclerosis and was not observed in any cases of simultaneous malleus ankylosis. Postoperative ABG was achieved to within 10 dB in 93.5% of cases in the pediatric series and in 94.5% of cases in the senior series. A significant postoperative SNHL (>15 dB) was seen in 0.7% of cases in the senior group but was not observed in the children. CONCLUSION: Using a new otologic database, our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement. The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis. Therefore, argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis. Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy. Our study shows that reasonable success rates can still be expected in these situations. Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications.

Asunto(s)

Audiometría de Tonos Puros , Conducción Ósea , Bases de Datos Factuales , Pérdida Auditiva Conductiva/cirugía , Internet , Prótesis Osicular , Otosclerosis/cirugía , Complicaciones Posoperatorias/diagnóstico , Cirugía del Estribo , Venas/trasplante , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anquilosis/cirugía , Umbral Auditivo , Niño , Femenino , Estudios de Seguimiento , Pérdida Auditiva Conductiva/diagnóstico , Humanos , Masculino , Martillo/cirugía , Sistemas de Registros Médicos Computarizados , Persona de Mediana Edad , Otosclerosis/diagnóstico , Estudios Prospectivos , Reoperación , Programas Informáticos

RESUMEN

OBJECTIVE: To report an original method of ossicular reconstruction with intact stapes and absent malleus. Ossiculoplasty is performed with a total ossicular replacement prosthesis positioned from the stapes footplate to the under-surface of the tympanic membrane, using a Silastic banding technique to stabilize the prosthesis. STUDY DESIGN: A prospective study of ossicular reconstruction using the Silastic banding technique. A consecutive series of cases with intact stapes superstructure and missing malleus handle (Austin-Kartush Group C) is presented. SETTING: One tertiary referral center. PATIENTS: Ninety-nine patients who underwent total ossicular reconstruction with Silastic banding technique were enrolled in the study from January 2000 to December 2002. INTERVENTIONS: Ossiculoplasty with total ossicular replacement prostheses with Silastic Rubber Band for chronic otitis media and non-inflammatory disease. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction threshold, and air-conduction threshold were assessed. Postoperative audiometry was performed at the 6th, 9th, 12th, 18th, 24th, and 36th months. RESULTS: Overall, a postoperative air-bone gap closed to within 10 dB was achieved in 61.5% of cases. An air-bone gap smaller than 20 dB was obtained in 77% of cases. Postoperative improvement of air-conduction thresholds by at least 20 dB was found in 51% of cases. There was no case of postoperative sensorineural hearing loss. One case of extrusion of the prosthesis was seen (1%). CONCLUSION: Stabilizing the total ossicular replacement prosthesis with the Silastic banding technique when performing ossicular reconstruction is a safe, effective method when the stapes supra-structure is present and the malleus absent.

Asunto(s)

Enfermedades del Oído/cirugía , Osículos del Oído/cirugía , Reemplazo Osicular/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Umbral Auditivo , Conducción Ósea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Reoperación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To prospectively evaluate the hearing results in surgically treated cases of stapes fixation in patients with osteogenesis imperfecta. STUDY DESIGN: A prospective study of osteogenesis imperfecta patients with stapes fixation. SETTING: One tertiary referral center. PATIENTS: Eighteen patients (23 ears) who underwent stapes surgery from 1994 to 2004 were prospectively included. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston or a bucket handle (cup) prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Postoperative audiometry was performed at 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Overall, a postoperative air-bone gap closure to within 10 dB was achieved in 85.7% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 57% of cases. The postoperative bone-conduction thresholds were unchanged. CONCLUSION: This study shows that safe and successful stapedotomy is possible in cases of stapes fixation in patients with osteogenesis imperfecta.

Asunto(s)

Umbral Auditivo , Osículos del Oído/cirugía , Osteogénesis Imperfecta/cirugía , Cirugía del Estribo/métodos , Adolescente , Adulto , Anciano , Audiometría de Tonos Puros , Conducción Ósea/fisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reoperación , Insuficiencia del Tratamiento , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The objective of this study was to report an original method of malleus relocation allowing for better placement of both partial and total prostheses in ossicular reconstruction. STUDY DESIGN: We conducted a retrospective review of clinical and audiometric findings. SETTING: A tertiary referral center. MATERIALS AND METHODS: This is a study of 268 patients who underwent ossiculoplasty surgery from October 1997 to October 2000 for chronic otitis media, noninflammatory disease, and otosclerosis revision. Malleus relocation with total and partial ossicular replacement prostheses was used in all cases. Audiometric assessment included pre- and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. RESULTS: A postoperative air-bone gap closed to within 10 dB was achieved in 56% of cases. An air-bone gap smaller than 20 dB was obtained in 78% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 41.5% of cases. The postoperative bone-conduction thresholds were unchanged in 98% of cases. One case of total postoperative sensorineural hearing loss was seen in this series (0.4%). Extrusion of the protheses was not observed in this series. Follow up ranged from 6 to 36 months (mean, 12.4 months). CONCLUSION: This study shows that malleus relocation is a safe and efficient technique for ossicular reconstruction. The ideal position of the relocated malleus allows easier and more stable placement of middle ear prostheses.

Asunto(s)

Martillo/cirugía , Prótesis Osicular , Otitis Media/cirugía , Procedimientos de Cirugía Plástica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Umbral Auditivo , Niño , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: Performing stapedotomy in cases of tympanosclerotic stapes fixation is controversial. The procedure is traditionally considered to carry a high risk of postoperative sensorineural hearing loss. The aim of this study was to report the hearing results in surgically treated cases of stapes fixation. STUDY DESIGN: A retrospective review of tympanosclerosis of the oval window with stapes fixation. SETTING: The study was performed at the Jean Causse Ear Clinic in Clombiers, France. PATIENTS: Sixty-five patients who underwent surgery for tympanosclerotic stapes fixation between January 1992 and October 1999. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston, or a total prosthesis in cases of incudal erosion. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone conduction threshold, air conduction threshold, and Glasgow Benefit Plot were measured. RESULTS: Postoperative air-bone gap closure to within 10 dB was achieved in 39% of cases. An air-bone gap less than 20 dB was obtained in 70% of cases. Significant postoperative improvement of air conduction thresholds, more than 20 dB, was found in 46% of cases. The postoperative bone conduction thresholds were unchanged in 92% of cases. No significant sensorineural hearing loss was seen in this series. CONCLUSION: This series demonstrates that safe and successful stapedotomy is possible if certain rules are respected.

Asunto(s)

Pérdida Auditiva Sensorineural/etiología , Otosclerosis/cirugía , Complicaciones Posoperatorias/etiología , Cirugía del Estribo/métodos , Adolescente , Adulto , Anciano , Audiometría de Tonos Puros , Umbral Auditivo/fisiología , Conducción Ósea/fisiología , Niño , Femenino , Pérdida Auditiva Sensorineural/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Prótesis Osicular , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Resultado del Tratamiento

Asunto(s)

Enfermedades Otorrinolaringológicas , Otolaringología

Asunto(s)

Otolaringología , Enfermedades Otorrinolaringológicas