RESUMEN
BACKGROUND: Ultra-high-resolution computed tomography (U-HRCT) utilizes a 1024 × 1024 matrix with 0.25-mm section thickness, offering better spatial resolution than conventional multi-detector row CT to detect anatomic data for otologic surgery. AIMS: We examined stapes footplate thickness using U-HRCT in relation to stapedotomy to predict the difficulty of the surgical procedure. MATERIALS AND METHODS: Subjects were 12 otosclerosis patients and 25 controls who underwent diagnostic U-HRCT. A profile curve (Hounsfield units) was used to measure stapes footplate thickness along a perpendicular line across the stapes footplate in a plane parallel to the lateral semicircular canal. RESULTS: Footplate thickness was smaller at the midpoint than just before the anterior crus and just after the posterior crus. Interobserver variability was lowest at the midpoint, where foot plate thickness was significantly greater in the affected ear in otosclerosis patients compared with controls (0.60 ± 0.09 mm vs 0.46 ± 0.04 mm; p < .001). Otosclerosis patients were detected using U-HRCT with a high area under the curve. Difficulty in the stapes opening procedure correlated with stapes footplate thickness. CONCLUSIONS: Footplate thickness on U-HRCT correlated with temporal bone anatomy and corresponded to surgical difficulty. Significance: U-HRCT-derived anatomic data is useful for evaluating the stapes.
Asunto(s)
Otosclerosis/patología , Cirugía del Estribo , Estribo/anatomía & histología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Prótesis Osicular , Otosclerosis/diagnóstico por imagen , Ventana Oval/patología , Curva ROC , Estudios Retrospectivos , Estribo/diagnóstico por imagen , Estribo/patología , Hueso Temporal/anatomía & histología , Hueso Temporal/diagnóstico por imagenRESUMEN
OBJECTIVES: To compare preoperative temporal bone high-resolution computed tomography (HRCT) readings to intraoperative findings during exploratory tympanotomy for suspected cases of isolated congenital middle ear malformations (CMEMs) and summarize the malformations that can and cannot be diagnosed with HRCT. METHODS: A retrospective study was conducted. All cases were confirmed as isolated CMEMs during surgery. Detailed clinical records were reviewed, with a focus on imaging and surgical findings. RESULTS: One hundred and thirty-two patients and 145 ears were reviewed. Ninety cases (62.1%) could be identified as isolated CMEMs and at least one as middle ear anomaly using preoperative HRCT. Fifty-five cases (37.9%) were reported to be completely normal and the patients underwent exploratory tympanotomy to determine the final diagnosis. Stapes fixation, either alone or associated with other ossicular chain anomalies, contributed to 53.1% of the cases. Most cases of aplasia or dysplasia of the ossicular chain, for example, aplasia/dysplasia of the long process of the incus, aplasia of the stapes' superstructure, and atresia of the oval window were easily identified in preoperative HRCT. However, fixation of the ossicular chain can be elusive in HRCT, and exploratory tympanotomy is needed for a definitive diagnosis. CONCLUSIONS: HRCT provides helpful preoperative clinical information in CMEM and may obviate the need for middle ear exploration in some cases. The negative findings (anomalies that are difficult to identify through preoperative HRCT) and the positive findings (anomalies that are relatively easy to identify through preoperative HRCT) were summarized.
Asunto(s)
Oído Medio/anomalías , Ventana Oval/anomalías , Adolescente , Adulto , Niño , Preescolar , Anomalías Congénitas/diagnóstico , Oído Medio/diagnóstico por imagen , Oído Medio/patología , Femenino , Pérdida Auditiva Conductiva/diagnóstico , Perdida Auditiva Conductiva-Sensorineural Mixta/diagnóstico , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Ventana Oval/diagnóstico por imagen , Ventana Oval/patología , Cuidados Preoperatorios , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
PURPOSE: The surgical treatment of otosclerosis can be challenging in case of anatomical abnormalities or variations of the oval window niche (OWN) area, as in very narrow OWN or in an overhanging facial nerve. The aim of the present study was to explore the role of endoscopic stapes surgery in cases with difficult OWN anatomy. METHODS: Patients undergoing endoscopic stapes surgery from 2008 to 2017, which fulfilled the CT scan criteria for a "difficult" anatomical condition, according to the measurements and cut-off values defined in the literature, were retrospectively selected. The intraoperative endoscopic view of the anatomical details and surgical difficulties were analysed through the review of the operative videos. Finally, a statistical analysis of the relationship between endoscopic visualization of anatomical details and radiological measurements was carried out. RESULTS: Eighteen out of 205 patients (8.7%) were included in the study. The 94.4% of patients obtained an optimal endoscopic exposure and visualization of all the anatomical details considered in the study, during each step of stapes surgery. The OWN measurements (width, depth and facial-promontory angle) did not affect significantly the endoscopic surgical exposure of the footplate or any of the other anatomical details. CONCLUSIONS: The anatomic features of the oval window area which reduce the visualization in microscopic surgery, did not affect the surgical exposure in endoscopic stapes surgery. Patients having a difficult anatomy of the OWN can be treated safely with the endoscopic approach. In the case of a predicted "difficult anatomy", the endoscopic approach can be considered a viable option.
Asunto(s)
Endoscopía/métodos , Otosclerosis/cirugía , Ventana Oval/patología , Cirugía del Estribo/métodos , Adulto , Oído Medio/patología , Oído Medio/cirugía , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios RetrospectivosRESUMEN
A 6-year-old girl presented with bilateral hearing loss. Her otologic, birth, and family histories were limited, given that she was adopted, but her parents reported that she had had difficulty hearing and speaking ever since they adopted her at 2 years of age. Her parents denied a history of acute otitis media, otorrhea, otalgia, vertigo, autophony, or tinnitus since her adoption. At 2.5 years of age, a diagnosis of hearing loss was made, and she was given hearing aids. Her parents believed that she had been doing well with both receptive and expressive language since she had received the hearing aids. At examination, she had small bilateral preauricular skin tags and normal pinna. Her external auditory canals were of a normal caliber bilaterally, with no otorrhea or lesions. The tympanic membranes were translucent and mobile at pneumatic otoscopy. There was no evidence of a middle ear lesion, nor was there a Schwartz sign. She had no nystagmus or vertigo at pneumatic otoscopy. Audiometry was performed and revealed moderate to severe conductive hearing loss bilaterally, with a mixed component present at 2000 KHz. She had normal bilateral middle ear pressure at tympanometry. Thin-section computed tomography (CT) of the temporal bone was performed.
Asunto(s)
Pérdida Auditiva Conductiva/diagnóstico por imagen , Ventana Oval/diagnóstico por imagen , Hueso Temporal/diagnóstico por imagen , Conducción Ósea , Niño , Diagnóstico Diferencial , Femenino , Pérdida Auditiva Conductiva/patología , Humanos , Ventana Oval/patología , Hueso Temporal/patología , Tomografía Computarizada por Rayos XRESUMEN
This study intends to identify factors that could better predict the diagnosis of perilymphatic fistula (PLF) since exploration surgery is currently the only confirmatory method. This retrospective chart review in a tertiary care center is based on all 71 available patient files operated for a suspicion of PLF between 1983 and 2012. History of predisposing factors, clinical findings and investigations were documented pre- and postoperatively. Patients were divided according to intraoperative findings into two groups: group I (fistula negative) and group II (fistula positive). In addition, group II was divided into two subgroups: patients with or without a history of stapedectomy. Both groups were demographically similar. With the exception of history of previous partial stapedectomy (p = 0.04), no statistical difference could be identified in predisposing factors and in clinical findings between the two groups. The evolution of symptoms showed an overall improvement of vestibular symptoms (91 %) and cochlear symptoms (53 %) postoperatively. Audiograms showed a significant improvement postoperatively in the pure tone audiometry and bone conduction threshold of group II while the air-bone gap and speech discrimination score did not improve. Group I did not show any significant improvement postoperatively in any audiogram parameter. This study failed to identify factors that could better predict the diagnosis of PLF. However, it shows that middle ear exploration with oval and round window obliteration is effective in PLF especially to decrease vestibular symptoms even when fistula is unidentified intraoperatively.
Asunto(s)
Oído Interno , Oído Medio , Fístula , Enfermedades del Laberinto , Cirugía del Estribo/métodos , Adulto , Audiometría de Tonos Puros/métodos , Barotrauma/complicaciones , Conducción Ósea , Traumatismos Craneocerebrales/complicaciones , Oído Interno/patología , Oído Interno/cirugía , Oído Medio/patología , Oído Medio/cirugía , Femenino , Fístula/diagnóstico , Fístula/etiología , Fístula/cirugía , Humanos , Enfermedades del Laberinto/diagnóstico , Enfermedades del Laberinto/fisiopatología , Enfermedades del Laberinto/cirugía , Masculino , Persona de Mediana Edad , Ventana Oval/patología , Ventana Oval/cirugía , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Ventana Redonda/patología , Ventana Redonda/cirugíaRESUMEN
The oval and round windows of the inner ear are important structures for the transmission of sound and may be affected by a variety of disease entities. The anatomy of this small area is one that often causes the radiology trainee some difficulty, but there are certain disease states that can be easily diagnosed when knowing where and how to look. As this area is very important to the otologist in a variety of preoperative settings, accurate assessment of the windows and recognition of important and potentially complex intra-operative anomalies, will greatly aid our surgical colleagues.
Asunto(s)
Diagnóstico por Imagen , Ventana Oval/patología , Ventana Redonda/patología , Colesteatoma del Oído Medio/diagnóstico , Implantes Cocleares , Humanos , Miringoesclerosis/diagnóstico , Otosclerosis/diagnóstico , Ventana Oval/anatomía & histología , Ventana Redonda/anatomía & histologíaRESUMEN
HYPOTHESIS: The purpose of this study is to offer new data about facial nerve malformations in the tympanic cavity. BACKGROUND: Prospective anatomic study of newborns to demonstrate the submacroscopic anatomy of the intratympanic facial nerve and its surrounding structures by malformations. METHODS: Step-by-step microdissection of 12 newborn temporal bones and histologic evaluation of 4 middle ears showing multiple malformations. RESULTS: Four of 12 temporal bones presented malformation in the middle ear. All 4 temporal bones showed developmental failures of the stapes, and 3 of them had malposition of the tympanic portion of the facial nerve. In 3 cases, there was an oval window atresia, and in 1 case, the rim of the oval window was not ossified and was positioned medial to the stapes. CONCLUSION: Malformation or displacement of the stapes can be an indirect sign for facial nerve malformation. The most common site for facial nerve malformation is the tympanic portion. The tympanic segment of the nerve is devoid of bony covering in association with these anomalies of the stapes.
Asunto(s)
Oído Medio/anomalías , Nervio Facial/anomalías , Hueso Temporal/anomalías , Cadáver , Oído Interno/anomalías , Oído Interno/patología , Oído Medio/patología , Nervio Facial/patología , Lateralidad Funcional , Humanos , Inmunohistoquímica , Recién Nacido , Ventana Oval/patología , Estribo/patología , Hueso Temporal/patología , Fijación del TejidoRESUMEN
BACKGROUND: Osteogenesis Imperfecta (OI) is a genetic disorder of connective tissue matrix. OI is caused by mutations that affect type I collagen. The hearing loss in OI is characterized by onset in early adulthood and can be conductive, sensorineural, or mixed. OBJECTIVES: To describe the temporal bone histopathology in 9 individuals with OI. MATERIALS AND METHODS: Four adult, 1 pediatric, and 4 infant specimens were identified. Temporal bones were removed at autopsy and studied using light microscopy. RESULTS: All adults and 1 pediatric specimen showed otosclerotic lesions. The findings included examples of clinical, histologic, and cochlear otosclerosis. The temporal bones of infants showed delayed ossification of the endochondral layer of bone and of the ossicles. There were no infant specimens with otosclerotic lesions. CONCLUSION: Hearing loss in OI may be the result of clinical or cochlear otosclerosis. Fracture or atrophy of the ossicles may also be present in OI. A third unidentified mechanism of hearing loss may lead to cochlear degeneration. The described findings of otosclerotic lesions have implications for the observed heterogeneity of hearing loss patterns and for the surgical management of hearing loss in OI.
Asunto(s)
Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/patología , Otosclerosis/etiología , Otosclerosis/patología , Hueso Temporal/patología , Adulto , Atrofia , Niño , Preescolar , Cóclea/patología , Osículos del Oído/patología , Femenino , Fracturas Óseas/patología , Pérdida Auditiva/etiología , Humanos , Lactante , Recién Nacido , Masculino , Órgano Espiral/patología , Ventana Oval/patología , Sistema de Registros , Ventana Redonda/patología , Sáculo y Utrículo/cirugía , Ganglio Espiral de la Cóclea/patología , Cirugía del EstriboRESUMEN
The objective of this study was to evaluate the histopathological incidence of facial canal dehiscence in otosclerosis cases compared with non-otosclerotic controls. 133 temporal bones from 84 otosclerosis (35 unilateral otosclerosis, 49 bilateral otosclerosis) cases were compared to 102 age-matched normal temporal bones from 70 subjects (38 unilateral normal cases, 32 bilateral normal cases). Temporal bones were serially sectioned in the horizontal plane at a thickness of 20 µm, and were stained with hematoxylin and eosin. We evaluated the location and the invasion of otosclerosis to the facial canal and incidence of facial canal dehiscence under light microscopy. Facial canal was subdivided into four portions: (1) the geniculate ganglion, (2) the tensor tympani muscle, (3) the oval window, and (4) mastoid. The incidence of facial canal dehiscence in otosclerosis [66 temporal bones (49.6%)] was significantly lower than normal controls [67 control temporal bones (65.7%)] in the oval window area (P = 0.019). Temporal bones with otosclerotic invasion to the thin bone of the canal were significantly less likely to have dehiscence [10 temporal bones (31.3%)] compared to the otosclerotic bones without invasion [56 temporal bones (55.5%)] (P = 0.025). There was no significant difference in the incidence of facial canal dehiscence between temporal bones with and without otosclerosis in the entire segment of facial nerve. Our findings in this study suggest that otosclerotic lesions have the potential to close dehiscence of the facial canal in the oval window area.
Asunto(s)
Nervio Facial/patología , Otosclerosis/patología , Hueso Temporal/patología , Anciano , Anciano de 80 o más Años , Cadáver , Estudios de Casos y Controles , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Ventana Oval/patología , Ventana Redonda/patología , Sensibilidad y EspecificidadRESUMEN
HYPOTHESIS: The purpose of this histopathological study is to examine temporal bones of patients with cochlear otosclerosis adjacent to the round window or adjacent to the oval window as compared with healthy controls. BACKGROUND: It is unclear if the extent and site of otosclerosis affects the extent of damage to cochlear structures and hearing loss. METHODS: Twelve temporal bones from 10 patients with cochlear otosclerosis adjacent to the round window, 11 temporal bones from 8 patients with cochlear otosclerosis adjacent to the oval window, and 12 bones of healthy age-matched controls were selected for study. We calculated the number of spiral ganglion cells, changes in cochlear structures, the extent and site of cochlear otosclerosis, and audiometric data. RESULTS: The loss of spiral ganglion cells and the absence of outer hair cells in patients with cochlear otosclerosis adjacent to the round window were significantly higher than those in patients with cochlear otosclerosis adjacent to the oval window and healthy controls. The area of the spiral ligament in patients with cochlear otosclerosis adjacent to the oval window was significantly smaller than that in healthy controls. However, no significant difference was found in the spiral ligament of patients with cochlear otosclerosis adjacent to the round window and healthy controls. There was no significant difference between patients with cochlear otosclerosis and age-matched controls in audiometric data. CONCLUSION: Cochlear otosclerosis adjacent to the round window caused significantly more damage to spiral ganglion cells and outer hair cells than cochlear otosclerosis adjacent to the oval window without loss of spiral ligament.
Asunto(s)
Células Ciliadas Auditivas/patología , Otosclerosis/patología , Ventana Oval/patología , Ventana Redonda/patología , Hueso Temporal/patología , Adulto , Anciano , Anciano de 80 o más Años , Audiometría , Umbral Auditivo , Conducción Ósea , Pérdida Auditiva Sensorineural/patología , Humanos , Persona de Mediana Edad , Ganglio Espiral de la Cóclea/patología , Ligamento Espiral de la Cóclea/patologíaRESUMEN
OBJECTIVE: To identify the causes of failure of primary stapes surgery and to evaluate the hearing results of revision stapes surgery in a consecutive series of 652 cases. STUDY DESIGN: Prospective nonrandomized clinical study. SETTING: Tertiary referral center. PATIENTS: Six hundred thirty-four patients who underwent 652 consecutive revision stapes operations from April 1992 to December 2007 were enrolled in this study. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry, namely, air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds, were assessed. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months and then annually for 15 years. RESULTS: The most frequently identified reason for primary surgery failure was incus erosion (27.6%) and prosthesis displacement (18.2%). The postoperative ABG was closed to 10 dB or less and 20 dB or less in 63.4 and 74.6% of cases, respectively. The mean 4-frequency postoperative ABG was 11.5 dB as compared with 28 dB preoperatively (mean difference, 16.5 dB; 95% confidence interval [CI], 15.1-17.9 dB, p < 0.0001). The mean 4-frequency postoperative air-conduction thresholds were 45.7 dB compared with 58.7 dB preoperatively (mean difference, 13 dB; 95% CI, 11.4-14.6 dB, p < 0.0001). The mean 4-frequency postoperative bone-conduction thresholds were 34 dB compared with 30.6 dB preoperatively (mean difference, -3.5 dB; 95% CI, -4.4 to -2.5 dB, p < 0.0001). A significant postoperative sensorineural hearing loss (>15 dB) was observed in 2.9% of cases in this series. CONCLUSION: Improvement of a conductive hearing loss after initial unsuccessful primary or revision stapes surgery can be accomplished with further revision but is occasionally modest.
Asunto(s)
Pérdida Auditiva Conductiva/cirugía , Cirugía del Estribo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Umbral Auditivo , Conducción Ósea/fisiología , Niño , Implantes Cocleares , Bases de Datos Factuales , Femenino , Fístula/patología , Humanos , Masculino , Persona de Mediana Edad , Ventana Oval/patología , Ventana Oval/cirugía , Perilinfa/fisiología , Estudios Prospectivos , Falla de Prótesis , Reoperación , Insuficiencia del Tratamiento , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Optical coherence tomography was used to study the stapes footplate, both in cadaveric temporal bones and during middle-ear surgery. MATERIALS AND METHODS: Optical coherence tomography was conducted on five temporal bone preparations (from two children and three adults) and in eight patients during middle-ear surgery. A specially equipped operating microscope with integrated spectral domain optical coherence tomography apparatus was used for standard middle-ear surgical procedures. RESULTS: This optical coherence tomography investigation enabled in vivo visualisation and documentation of the annular ligament, the different layers of the footplate and the inner-ear structures, both in non-fixed and fixed stapes footplates. In cases of otosclerosis and tympanosclerosis, an inhomogeneous and irregularly thickened footplate was found, in contrast to the appearance of non-fixed footplates. In both fixed and non-fixed footplates, there was a lack of visualisation of the border between the footplate and the otic capsule. CONCLUSIONS: Investigation of the relatively new technology of optical coherence tomography indicated that this imaging modality may assist the ear surgeon to assess the oval window niche intra-operatively.
Asunto(s)
Enfermedades del Oído/diagnóstico , Interpretación de Imagen Asistida por Computador/instrumentación , Ventana Oval/patología , Tomografía de Coherencia Óptica/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Humanos , Periodo Intraoperatorio , Persona de Mediana Edad , Otosclerosis/patología , Otosclerosis/cirugía , Ventana Oval/cirugía , Estribo , Hueso Temporal/patología , Adulto JovenAsunto(s)
Enfermedades Cocleares/patología , Otosclerosis/patología , Hueso Temporal/patología , Autopsia , Sordera/patología , Lateralidad Funcional , Humanos , Ventana Oval/patología , Neoplasias Pancreáticas/patología , Ventana Redonda/patología , Estribo/patología , Membrana Timpánica/patología , Perforación de la Membrana Timpánica/patologíaRESUMEN
BACKGROUND: CT and MRI of the windows of the temporal bone have become an important tool in the analysis of malformation, trauma and chronic otitis media. Optical Coherence-Tomography (OCT) provides optical cross-sections of the tissue, comparable to ultrasound. In a study on temporal bone specimens and during middle ear surgery we tested, whether OCT provides information about the oval window niche. MATERIAL AND METHODS: OCT was performed ex vivo on five human temporal bone preparations, in which the oval window niche was exposed and in vivo in eight patients who underwent middle ear surgery. A new OCT device, which based on spectrally resolved detection of the interference signals, was used. This OCT technology was fully integrated into an operating microscope. For direct correlation between OCT-scans and histology, three temporal bones were used. RESULTS: On all ex and in-vivo scans OCT supplies information about morphology of the stapes footplate. This OCT investigation documents the possibility to visualize in vivo annular ligament, different layers of the FP and inner ear structures. CONCLUSIONS: Intra-operative OCT application will help to visualize FP anomalies. Our study provides morphological information of the FP that may help in stapes surgery of the patients concerned.
Asunto(s)
Procesamiento de Imagen Asistido por Computador/instrumentación , Imagenología Tridimensional/instrumentación , Periodo Intraoperatorio , Microcirugia/instrumentación , Otitis Media/cirugía , Otosclerosis/cirugía , Ventana Oval/cirugía , Cirugía del Estribo/instrumentación , Tomografía de Coherencia Óptica/instrumentación , Timpanoplastia/instrumentación , Humanos , Prótesis Osicular , Otitis Media/patología , Otosclerosis/patología , Ventana Oval/patología , Sensibilidad y Especificidad , Hueso Temporal/patología , Hueso Temporal/cirugíaRESUMEN
OBJECTIVE: Middle-turn cochleostomies are occasionally used for cochlear implant electrode placement in patients with labyrinthitis ossificans. This study evaluates the anatomic characteristics of the middle-turn cochleostomy and its suitability for placement of implant electrodes. METHODS: Ten cadaveric human temporal bones were dissected using a facial recess approach. A middle-turn cochleostomy was drilled 2 mm anterior to the oval window and just inferior to the cochleariform process. The preparations were then stained with osmium tetroxide and microdissections were performed. The location of the cochleostomy on the cochlear spiral and its path through the various cochlear compartments were evaluated in all 10 specimens. A Cochlear Corporation depth gauge was inserted in five of the specimens and insertion trauma, number of contact rings, and depth of insertion were recorded. RESULTS: Eight of the 10 cochleostomies were placed at approximately 360 degrees on the cochlear spiral, near the transition between the basal and middle turns. In one case, the cochleostomy was found to enter the cochlear apex and in another it entered scala vestibuli of the proximal basal turn. The cochleostomy entered scala media in six bones and scala vestibuli in four specimens. A depth gauge was inserted in five specimens. The number of contacts placed within the cochlear lumen ranged from four to nine. There was evidence of insertional trauma to the lateral wall of the cochlear duct, basilar membrane, and Reissner's membrane, but no evidence of fractures to the osseous spiral lamina or modiolus. CONCLUSION: This study demonstrates that electrodes inserted via a middle-turn cochleostomy are likely to enter scala vestibuli and have access to the middle- and apical-cochlear turns. It is also possible that the electrode could be directed into the descending portion of the basal turn depending on cochleostomy orientation. Middle-turn cochleostomy seems to be a viable alternative for electrode placement when preservation of residual hearing is not a concern.
Asunto(s)
Cóclea/patología , Cóclea/cirugía , Implantación Coclear , Electrodos Implantados , Membrana Basilar/patología , Membrana Basilar/cirugía , Humanos , Laberintitis/patología , Laberintitis/cirugía , Osificación Heterotópica/patología , Osificación Heterotópica/cirugía , Ventana Oval/patología , Ventana Oval/cirugía , Rampa Timpánica/patología , Rampa Timpánica/cirugía , Ligamento Espiral de la Cóclea/patología , Ligamento Espiral de la Cóclea/cirugía , Hueso Temporal/patología , Hueso Temporal/cirugíaRESUMEN
OBJECTIVE: To have a new macroscopic classification of otosclerosis based on appearance variations of the stapes footplate due to the disease and to determine if the color variations are correlated to a minor or major incidence of footplate complications. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: From January 2006 to December 2006, 106 patients affected by otosclerosis underwent surgery. Three revision procedures (1 primarily operated in our department and 2 elsewhere) were excluded from the study. We finally considered 103 surgical procedures. In all patients, the appearance of stapes footplate before removing superstructure was assessed to determine a simplified rating of stapedial otosclerosis. We then excluded from the study group 7 patients in which the footplate was not visible (obliterative otosclerosis). Finally, we considered 96 otosclerosis patients divided into 2 groups (Groups A and B) that differed only in footplate color. Group A included 74 otosclerosis patients with blue footplate (77%), and Group B included 22 otosclerosis patients with white footplate (23%). We planned a stapedotomy procedure for all patients of Groups A and B. The surgeon, anesthesia, approach, succession of surgical steps, and type of surgical instruments were the same in all patients. We estimated whether there is statistical correlation between the incidence of footplate complications (floating footplate and footplate fracture) and the color variations of the stapes footplate in Groups A and B. MAIN OUTCOME MEASURES: Color footplate, incidence of footplate complications (floating and fractures footplate). RESULTS: The visible portion of stapes footplate before removing superstructure preserves the natural blue color in all its points in 71.84% of patients (n = 74). In 21.36% of patients (n = 22), the footplate appears white in all or in most of its extent. In 6.8% of patients (n = 7), the footplate was not visible because it was covered by massive otospongiotic tissue. Comparison of incidence of footplate complications between Groups A and B showed statistical significance. The incidence of footplate complications is higher in white otosclerosis than in blue otosclerosis. CONCLUSION: Based on the appearance and, furthermore, on the color of the visible portion of stapes footplate, before removing superstructure, the authors have formulated a new classification of otosclerosis: blue otosclerosis (blue footplate), white otosclerosis (white footplate), and obliterative otosclerosis (nonvisible footplate). The advantage of this classification is that it consents, before making any manipulation on the stapes, a rapid and simple identification of the different degrees of difficulty of surgery: I degree, blue otosclerosis; II degree, white otosclerosis; and III degree, obliterative otosclerosis.
Asunto(s)
Otosclerosis/cirugía , Ventana Oval/cirugía , Cirugía del Estribo/métodos , Audiometría/métodos , Femenino , Fenestración del Laberinto/efectos adversos , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Humanos , Masculino , Martillo/cirugía , Otosclerosis/patología , Ventana Oval/patología , Selección de Paciente , Estribo/patología , Movilización del Estribo/efectos adversosAsunto(s)
Fístula/diagnóstico , Fístula/terapia , Ventana Oval/patología , Enfermedades Vestibulares/diagnóstico , Enfermedades Vestibulares/terapia , Implantación Coclear , Mareo , Femenino , Fístula/fisiopatología , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Sensorineural/terapia , Humanos , Persona de Mediana Edad , Otoscopía , Enfermedades Vestibulares/fisiopatologíaAsunto(s)
Fístula/etiología , Pérdida Auditiva Súbita/etiología , Perilinfa , Neumocéfalo/complicaciones , Estribo/lesiones , Perforación de la Membrana Timpánica/complicaciones , Membrana Timpánica/lesiones , Audiometría de Tonos Puros , Femenino , Fístula/diagnóstico , Fístula/cirugía , Estudios de Seguimiento , Pérdida Auditiva Súbita/diagnóstico , Pérdida Auditiva Súbita/cirugía , Humanos , Persona de Mediana Edad , Otoscopios , Ventana Oval/lesiones , Ventana Oval/patología , Neumocéfalo/diagnóstico , Neumocéfalo/cirugía , Estribo/patología , Tomografía Computarizada por Rayos X , Membrana Timpánica/patología , Perforación de la Membrana Timpánica/diagnóstico , Perforación de la Membrana Timpánica/cirugíaRESUMEN
Perilymphatic fistula (PLF) is often difficult to diagnose because of the similar symptomatology, such as vertigo, tinnitus and hearing loss, which is found in several inner ear diseases. We attempted to correlate a positive result of low frequency sound (LFS) stimulation tests in posturography with the presence or absence of a PLF confirmed by transtympanic endoscopy in 209 patients with various inner ear diseases (Meniere's disease ( n=128), vestibulopathy ( n=41), cochleopathy ( n=28) and sudden deafness ( n=12). LFS provoked unsteadiness in posturography without PLF in 24 patients with Meniere's disease, in 5 patients with vestibulopathy, in 3 patients with cochleopathy and in 2 patients with sudden deafness. In one patient, tympanoscopy revealed fistula in the round window membrane that was covered with a fibrinous layer. In four cases there was abnormal light reflex in the round window but without PLF. In eight cases, Hennebert's sign was present with nystagmus, without PLF. We conclude that pathological responses to the LFS test in posturography can also be encountered in other inner ear diseases without PLF.
Asunto(s)
Acueducto Coclear , Fístula/diagnóstico , Pérdida Auditiva Sensorineural/etiología , Enfermedades del Laberinto/diagnóstico , Vértigo/etiología , Pruebas de Impedancia Acústica , Estimulación Acústica , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Acueducto Coclear/patología , Acueducto Coclear/fisiopatología , Diagnóstico Diferencial , Oído Medio/patología , Femenino , Fístula/complicaciones , Fístula/fisiopatología , Humanos , Enfermedades del Laberinto/complicaciones , Enfermedades del Laberinto/fisiopatología , Masculino , Persona de Mediana Edad , Otoscopía , Ventana Oval/patología , Equilibrio Postural , Ventana Redonda/patologíaRESUMEN
Chronic subjective tinnitus is a common feature of clinical otosclerosis. Analysis of the records of 1,014 consecutive cases of clinical otosclerosis, all confirmed by stapes surgery in South Australia between 1960 and 1972, gives a preoperative prevalence of this symptom of 65%. The association of tinnitus with various predictors is considered, and a statistical analysis is presented. Tinnitus has an association with gender (p < .0001), mean preoperative bone conduction (BC) level (p = .0012), mean air conduction (AC) level (p = .0192), and mean air-bone gap (p = .0075). The associations between tinnitus and the age of the patient, the duration of deafness, the presence of Schwartze's sign, and the severity of footplate pathological involvement were all nonsignificant. The association of tinnitus with the AC and BC thresholds is unexpectedly paradoxical. An economic predictive model for tinnitus in otosclerosis has been constructed from the 2 strongly significant variables, gender and mean BC hearing level, by logistic regression. In this large series of cases, the log odds in favor of finding tinnitus are about 0.810 for male subjects and 1.394 for female subjects when the BC level is zero. The log odds fall by 0.014 for each decibel of mean BC rise.