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Abstract Introduction Stapes surgery for otosclerosis is a precise surgical procedure. To achieve excellent hearing results, a firm and stable attachment of the prosthesis to the long process of incus (LPI) is necessary. The present study provides details on the attachment site in two dimensions to choose an appropriate prosthesis and to ensure firm attachment for better surgical outcomes. Objective To study the diameter of the LPI and its relevance in determining the piston, used in stapes surgery by an in vivo method. Methods This study was conducted in 41 patients who underwent stapedotomy, where both Anteroposterior (AP) and Mediolateral (ML) diameters of the LPI were measured at the site of attachment of the piston using specially designed instruments, intraoperatively. Radiological data were obtained to measure the LPI diameter from the normal ears of 46 patients. It was measured from both the right and left side, hence 92 LPI diameters were obtained. Results The most commonly used site for prosthesis attachment is between 1-1.5 mm away from the tip of the LPI. We found great variability in the diameters of LPI in the attachment site, with the AP diameter ranging between 0.6 -1.5mm and the ML diameter ranging between 0.5mm-1.2mm. Conclusion Pistons by design have characteristics of gripping incus that will vary between types. Based on LPI dimensions, ideal piston types with appropriate inner loop diameters are suggested in this study. HRCT before surgery should include measurements of the LPI as a guide to the choice of the prosthesis during surgery.
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Introduction Stapes surgery for otosclerosis is a precise surgical procedure. To achieve excellent hearing results, a firm and stable attachment of the prosthesis to the long process of incus (LPI) is necessary. The present study provides details on the attachment site in two dimensions to choose an appropriate prosthesis and to ensure firm attachment for better surgical outcomes. Objective To study the diameter of the LPI and its relevance in determining the piston, used in stapes surgery by an in vivo method. Methods This study was conducted in 41 patients who underwent stapedotomy, where both Anteroposterior (AP) and Mediolateral (ML) diameters of the LPI were measured at the site of attachment of the piston using specially designed instruments, intraoperatively. Radiological data were obtained to measure the LPI diameter from the normal ears of 46 patients. It was measured from both the right and left side, hence 92 LPI diameters were obtained. Results The most commonly used site for prosthesis attachment is between 1-1.5 mm away from the tip of the LPI. We found great variability in the diameters of LPI in the attachment site, with the AP diameter ranging between 0.6 -1.5mm and the ML diameter ranging between 0.5mm-1.2 mm. Conclusion Pistons by design have characteristics of gripping incus that will vary between types. Based on LPI dimensions, ideal piston types with appropriate inner loop diameters are suggested in this study. HRCT before surgery should include measurements of the LPI as a guide to the choice of the prosthesis during surgery.
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The social and economic roles of goat farming in Northeastern Brazil, allied to the fact that the use of goat middle ear ossicles for research and human ear surgery training has not yet been proposed, justify the study of their applicability as an experimental model. The middle ears of 19 goats (Capra aegagrus hircus) from the bone collection of the Laboratory and Didactic Anatomy Museum of Domestic and Wild Animals of the Federal University of Vale do São Francisco (UNIVASF) were dissected. The malleus, incus, and stapes were evaluated regarding their macroscopic morphology and biometry (length, width, and height). Ossicle morphology was similar to sheep, human, and bovine morphology. The malleus was 1.3 times heavier and 2.2 times longer than the incus, and 9.0 times heavier and 3.7 times longer than the stapes. The size relationship was positive between the stapes and the malleus and negative between the stapes and the incus. It is concluded that the middle ear size and the anatomical similarities with human ossicles make goats a useful model for experimental scientific studies, reconstructive surgery practice of the ossicular chain, and human ear surgery training.(AU)
Tanto o papel social quanto o econômico da caprinocultura na região Nordeste do Brasil, somados ao fato de que o uso de ossículos da orelha média de caprinos para estudos e treinamento cirúrgico otológico humano ainda não foi proposto, justificam o estudo de sua aplicabilidade como modelo experimental. Foram dissecadas as orelhas médias de 19 caprinos (Capra aegagrus hircus), provenientes do ossuário do Laboratório e Museu Didático de Anatomia dos Animais Domésticos e Silvestres - Universidade Federal do Vale do São Francisco. Martelos, bigornas e estribos tiveram a morfologia macroscópica e a biometria (comprimento, largura e altura) avaliadas. A morfologia dos ossículos assemelhou-se a de ovinos, humanos e bovinos. O martelo foi 1,3 vez mais pesado e 2,2 vezes mais comprido que a bigorna e 9,0 vezes mais pesado e 3,7 vezes mais comprido que o estribo. A relação de tamanho entre o estribo e o martelo foi positiva, e entre o estribo e a bigorna negativa. Conclui-se que o tamanho da orelha média e as semelhanças anatômicas com os ossículos humanos tornam os caprinos um modelo útil para estudos científicos experimentais, prática cirúrgica reconstrutiva da cadeia ossicular e treinamento cirúrgico otológico humano.(AU)
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Animais , Estribo/anatomia & histologia , Cabras/anatomia & histologia , Ossículos da Orelha/anatomia & histologia , Bigorna/anatomia & histologia , Martelo/anatomia & histologia , Biometria , Modelos AnimaisRESUMO
Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.
Assuntos
Humanos , Masculino , Feminino , Adulto , Otite Média/cirurgia , Cartilagem da Orelha/transplante , Bigorna/cirurgia , Estribo/transplante , Timpanoplastia , Doença Crônica , Resultado do Tratamento , Estudos Controlados Antes e Depois , Perda Auditiva/cirurgiaRESUMO
Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage ( p < 0.001). There was no statistically significant change in bone conduction ( p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from 11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.
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OBJECTIVE: To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. DESIGN: Prospective, randomised surgical trial comparing no intervention with incus interposition over a 5-year period. SETTING: Tertiary referral hospital. PARTICIPANTS: Seventy-six participants with simple chronic otitis media and erosion of the long process of the incus but apparent good transmission throughout the ossicular chain as tested intra-operatively. Forty-four patients had partial erosion of the incus but still bony contact with the stapes head (Group A-Type I), and 32 had mainly connective tissue binding the incus and stapes (Group B-Type II). Each of these groups was randomised to either leaving the ossicular chain as it was (A1 and B1) or performing an incus interposition (A2 and B2). MAIN OUTCOME MEASURES: Average postoperative air-bone gap and the degree of ABG closure. A postoperative air-bone gap under 20 dB was considered a successful result. RESULTS: In group A, there was no significant difference between no intervention and incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the incus interposition subgroup (postoperative air-bone gap of 27.5 dB and 31% closure within 20 dB vs 15 dB and 75% closure). CONCLUSIONS: For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favour reconstruction.
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Condução Óssea/fisiologia , Tomada de Decisões , Perda Auditiva Condutiva/cirurgia , Bigorna/cirurgia , Prótese Ossicular , Otite Média/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Audiometria de Tons Puros , Doença Crônica , Feminino , Seguimentos , Audição/fisiologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The Vibrant Soundbridge is an active middle-ear implant for hearing rehabilitation that is usually placed in the long process of the incus or round window. This study reports on the unusual implant attachment to the short process of the incus in a patient with ear malformation, and describes their audiological and clinical outcomes. METHODS: Case report and literature review. RESULTS: Audiological evaluation with the Vibrant Soundbridge implant showed a pure tone average of 31 dB. The speech test, at 65 dB HL, revealed correct recognition of 92 per cent of disyllabic words. The Glasgow Hearing Aid Benefit Profile showed high levels of satisfaction, hearing aid use and benefit. CONCLUSION: Fixation of the Vibrant Soundbridge implant on the short process of the incus is a feasible option, with good clinical and audiological outcomes. Coupling the floating mass transducer to the short process of the incus is a good surgical option, especially when the long process and the oval or round window are inaccessible.
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Prótese Ossicular , Substituição Ossicular/métodos , Adolescente , Audiometria de Tons Puros , Orelha/anormalidades , Orelha/cirurgia , Audição , Humanos , Bigorna/cirurgia , Masculino , Resultado do TratamentoRESUMO
Los estudios actuales sobre variaciones anatómicas del yunque en humanos a partir del registro morfométrico son insuficientes. Las características estructurales y dimensionales del yunque son registradas en 23 muestras de población mestiza adulta Colombiana. Las medidas registradas involucraron el cuerpo, la articulación incudo-maleolar, el proceso largo, el proceso corto y la articulación incudo-estapedial. Solo ocho de los treinta y cinco registros tomados en este estudio pudieron ser comparados concienzudamente con otros estudios anteriores que mostraron similitudes. El largo total del yunque fue de 6,51 mm (DE 0,32), la longitud del proceso largo del yunque fue de 5,35 mm (DE 0,25), la distancia entre proceso largo y corta fue de 6,06 mm (DE 0,35) y la proporción de longitudes entre ambos procesos fue de 82,18 por ciento (DE 8,9). Conforme a la población estudiada se encontró variación pareada en la anatomía del yunque en solo tres de los registros tomados, sin embargo, consideramos que es un hueso morfométricamente uniforme y estable.
Current studies on anatomical variations of the incus in humans from the morphometric register are insufficient. Structural and dimensional characteristics of the incus are registered in 23 samples of Colombian adult mestizo population. Registered measures involved incus body, incudo-maleolar joint, long process, short process and incudo-stapedial joint. Only eight of the thirty-five records taken in this study could be thoroughly compared to other anterior studies, which showed similarities. The total length of the anvil was 6,51 mm (SD 0.32), the length of the long process of the incus was 5.35 mm (SD 0.25), the distance between processes long and short was 6.06 mm (SD 0.35) and the ratio of lengths between both processes was 82.18 percent (SD 8.9 percent). In accordance with the studied population we found paired variation in the anatomy of the incus in only three of the records taken, however, we believe that it is a uniform and morphometrically stable bone.
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Humanos , Antropometria , Bigorna/anatomia & histologiaRESUMO
The mechanism for conducting acoustic energy via middle ear oscicles is still a controversial topic and will remain so until consensus is reached regarding whether it amplifies or reduces sound transmission. 22 paired human temporal bone blocks and 1 left block were studied. Digital measurements were taken of the tympanic membrane, oscicular articulations and the oval window; the results were then correlated. A relationship of non-lineal areas was found amongst the structures being studied, suggesting a sound transmission relationship combining both sound reduction and amplification. A complex relationship of levers could be observed originating in an oscicular and articular asymmetric relationship suggesting an amplifying function in initial sound transmission and also a final reducer destination for such conduction.
El mecanismo para conducir la energía acústica a través de oscículos del oído medio es todavía un tema controvertido y lo seguirá siendo hasta alcanzar un consenso con respecto a si se amplía o reduce la transmisión del sonido. Fueron estudiados 22 pares de bloques de hueso temporal izquierdo y uno derecho hmanos. Mediciones digitales fueron tomadas de la membrana timpánica, articulaciones osciculares y de la ventana oval, siendo estos resultados correlacionados. Una relación de las áreas no-lineal se encontró entre las estructuras, lo que sugiere una relación de transmisión de sonido que incluye tanto la reducción de sonido y amplificación. Una compleja relación de las palancas se pudo observar originando una relación oscicular y articular asimétrica, lo que sugiere una función de amplificación de la transmisión del sonido inicial y también un destino reductor final para su conducción.