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OBJECTIVE: to evaluate the effectiveness of stapes surgery for improving tinnitus symptoms.
MATERIALS AND METHODS: This prospective study included 29 patients with surgically proven otosclerosis, who had undergone stapedectomy or stapedotomy. CONCLUSION: We conclude that stapes surgery is quite effective for treatment of tinnitus as well as improvement of hearing. Otosclerosis is a common cause of progressive hearing loss in patients with an intact tympanic membrane. Several treatment options such as hearing aids, fluoride, biphosphonates, and stapes surgery are available1. The goal of this study was to determine the incidence of tinnitus, and its discomfort level in otosclerosis patients, using the Newman method16, and to evaluate the effectiveness of stapes surgery for improving tinnitus as well as hearing levels. This prospective study included 29 patients with otosclerosis aged between 13 and 65 years old.
Stapes surgery was performed under general anesthesia in 12 patients and local anesthesia in 18 patients depending on the patient's or surgeon's preference.
Before and after the surgery standard audiometry including speech recognition threshold (SRT), speech discrimination score (SDS), air bone gap (ABG), pure tone average for air conduction (AC) and bone conduction (BC) at 4 frequencies (0.5, 1, 2, 4 kHz), and a tympanogram were performed in all patients. A total of 29 patients with a mean age of 39 years (range: 13-65) were included in the study, 20 were female and 9 were male.
On the first day after surgery, tinnitus was aggravated in 3 patients, unchanged in 5 patients, and improved in 21 patients. Interestingly, 2 of the 3 patients who did not have tinnitus before surgery experienced a short episode of tinnitus postoperatively which disappeared completely within one month of surgery. The mean of the pre- and post-operative SRT, ABG, AC, and BC results are presented in Table 3. In this study discomfort from tinnitus before surgery was not associated with hearing level. In another approach, Gristwood studied 1014 otosclerotic patients who had a 65% incidence of tinnitus and observed that preoperative tinnitus was significantly correlated with gender, mean AC, mean BC, and ABG.
In terms of predicting post-operative outcomes, Ayache and Szymanski stated in their studies that there was not any parameter that could predict the tinnitus status postoperatively5,10.
Stapes surgery can successfully improve tinnitus as well as hearing levels in patients with otosclerosis. Paper submitted to the RBCMS-SGP (Publishing Management System) on April 20, 2012; and accepted on August 16, 2012. Stapedectomy: A guide to operations, procedures and medical investigations provided by Surgery Door. We compared symptomatic (tinnitus, hearing loss, and vertigo) and audiological findings obtained before and after surgery. When deciding upon management in patients with otosclerosis the presence of tinnitus should be considered as well as hearing level. The study protocol was approved by the ethics committee of Mashhad University of Medical Sciences and informed consent was obtained from all patients. Stapedectomy was performed in 4 cases and 25 patients underwent stapedotomy, where the same technique was used for all procedures. The level of discomfort caused by tinnitus was graded using Newman's method with scores from grade I to V. Fisher's Exact test and Student's paired t-test were used to compare hearing levels and tinnitus discomfort levels before and after surgery. According to Newman's grading method, 2 patients had grade I tinnitus, 4 patients had grade II, 11 patients had grade III, and 9 patients had grade IV tinnitus.
One week after surgery tinnitus was worsened in one patient, unchanged in 5 patients, and improved in 23 patients in comparison with the preoperative status. Vertigo happened during the surgery in 9 out of the 18 patients who did not receive general anesthesia. Patients with otosclerosis often also suffer from subjective tinnitus that can be severe and disabling.
However, it wasn't associated with age, duration of hearing loss, and degree of footplate involvement21.
However, Gersdorff and Sakai showed that the surgical technique used was important in the outcomes related to tinnitus and that better results were achieved by stapedotomy as opposed to stapedectomy7- 8. Thus, patients suffering from discomfort caused by tinnitus could be good candidates for stapes surgery. Otorhinolaryngology-Head & Neck Surgery - Mashhad University of Medical Sciences - Mashhad - AC - Iraque. Otorhinolaryngology-Head & Neck Surgery, Otorhinolaryngology-Head & Neck Surgery Department, Imam Reza Educational Hospital - Mashad University of Medical Sciences - Mashhad - Iraque. MD; Associate professor of the Ear, Nose and Throat Research Center, Emmam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences. Otorhinolaryngology-Head & Neck Surgery Department - Mashhad University of Medical Sciences - Mashhad - Iraque. Using Newman's method the level of discomfort caused by tinnitus was scored from grade I to V pre- and postoperatively.

The technique has been shown to improve hearing, is well established with a long history, and has been proven to be effective in several studies. A total of 25 Teflon-piston and 4 titanium (Big Easy) prostheses, one of which was offset (inclined), were used in this study. Follow-up visits were conducted on the first day, the end of the first week, and the end of the first month after surgery and the patients were asked about tinnitus and vertigo. We evaluated the association of presumed risk factors with the outcome of surgery on tinnitus using Pearson's correlation and Student's independent t-test. One patient had pure conductive hearing loss and all others had a concomitant bone conduction deficit to some extent (mixed hearing loss). On the third visit, one month after surgery, 24 patients had complete or partial recovery (82.8%) from tinnitus and in 5 patients their tinnitus remained unchanged.
In the first day after the operation, 2 patients had severe vertigo which required medical therapy and another 13 patients reported mild vertigo. In this study, tinnitus was present in 89.7% of our otosclerosis patients, 31% of whom suffered from severe disabling tinnitus. Causse and Vincent proposed that some causes of tinnitus in otosclerotic patients could include poor vibration of the inner ear fluid, fixation of the foot plate, proteolysis of Corti hair cells, acoustic trauma, and spiral ligament hyalinization that impairs blood supply to the inner ear via the stria vascularis18-19. Similarly, in this study we didn't find any risk factors for predicting tinnitus discomfort before surgery or its recovery one month later. Incontrast, Merchese and House achieved similar hearing results (ABG closure) with both techniques13- 14.
The comparative analysis of clinical symptomatology before and after the operation of otosclerosis. The pathological process underlying the disease is an inflammatory lysis and remodeling of the bony labyrinth and a variety of etiologies such as genetic, vascular, viral (especially Measles), and hormonal factors are believed to play a role in the development of the condition. Although surgery is not traditionally indicated for treating tinnitus alone, many patients report alleviation of tinnitus after surgery5-15.
The grade of tinnitus present was determined at each of the post-operative visits and postoperative audiometry was done one month after surgery.
In 16 patients hearing loss was bilateral and we selected the ear with the worst hearing for stapes surgery. Grade IV and V tinnitus is considered to be severe disabling tinnitus and 9 cases were included in this group; the other 17 patients with tinnitus had mild to moderate discomfort.
Similarly, Ayache reported the presence of tinnitus in 74% of otosclerosis patients, 24.6% of whom had severe disabling tinnitus5. Tinnitus in otosclerosis could also be attributed to stapes immobility and conductive hearing loss which may be capable of causing limited and reversible changes in central auditory pathways.
Sparano and Sobrinho indicated that smaller postoperative ABG was associated with better tinnitus recovery11-12, but in Terzic's study gap closure was not associated with tinnitus improvement22. Here is the story of my diagnosis, surgery with fortunately no complications, and the excellent result in hearing improvement. The exclusion criteria were previous stapes surgery on the same ear and unconfirmed stapedius fixation during surgery.
Before the procedure all patients had negative Rinne tests at 512 Hz in the ear selected for surgery. There was no significant association between tinnitus severity and other parameters such as age, sex, and family history of otosclerosis. One month after surgery 3 patients had mild vertigo and the rest of them had no balance complaints. In studies by Oliviera and Del Bo, 91% and 56% of patients, respectively, were reported to be annoyed by tinnitus6,17.
In our study significant hearing improvement was achieved after surgery with ABG measurements of less than 20 dB one month after surgery observed in 24 patients (82.8%). I should be getting a hearing test again by the end of 2010 and I will post all the details here also.
Patients are frequently between 15 to 50 years old on presentation and one half of patients also have a positive family history of the disease1-4. Patients' data, including age, gender, family history of otosclerosis, and the occurrence of vertigo, were recorded in a checklist. Furthermore, the patients' levels of tinnitus discomfort were not associated with their preoperative hearing levels (SRT, ABG, and AC) (Table 1). In our study 3 patients did not complain of tinnitus before surgery, in 2 of them tinnitus ensued after surgery but was completely resolved within one month. Stapes surgery not only reduces conductive hearing loss but also improves the mechanics of the cochlear fluid, as explained by Szymanski10, and this may account for tinnitus recovery without hearing improvement in some patients.
In addition, tinnitus recovery after surgery was positively correlated with conductive hearing recovery (SRT, mean AC, ABG). In Del Bo's study tinnitus started in 7% of patients postoperatively, contrary to Ayache, who reported no similar cases5,17. The new "BeamPath" CO2 laser fiber acts as a precise surgical scalpel and is used to treat different forms of hearing impairment or deafness . It is a very safe treatment and minimally invasive treatment for conditions such as Otosclerosis (Stapes surgery) and Cholesteatoma, as well as for gentle removal of scar tissue and adhesions from delicate sturctures in the middle ear.Operative Options Not all hearing losses can be helped with hearing aids.

In this video, surgical and technological options are discussed that can benefit those who are not hearing aid candidates. The Lippy Group Hearing Aid Center is a department of the Lippy Group for Ear, Nose and Throat, a premier medical practice serving the hearing needs of patients for over 45 years. Bliouras Konstantinos Left Stapedectomy (sta***tomy) This video demonstrates a typical surgery of the ear for correction of otosclerosis (when the ear bones get stuck). Otosclerosis is caused by fixation of the foot plate of stapes which prevents efficient sound transmission to the oval window. Fortunately, as explained in this video, the percentage of satisfied patients is very high when there are realistic expectations.
See more at Revision Stapes- "Small Fenestra" Fenestra made earlier is too small and resulted in conductive hearing loss.
Hence we attempted revision sta***tomy and widened the fenestra and placed piston between long process of incus and fenestra and this patient recoversd normal hearing 2 weeeks after this surgery in KKR ENT Hospital and research Institute, Chennai, India.Temporal Bone Dissection 2008 Anatomy of middle ear and inner ear.
Unique approach to stapedectomyStapedectomy For more information please visit www.rph-Revision Stapes Partial Transc*** Labyrinthectomy This patient underwent stapedectomy in another hospital came to KKR ENT Hospital with severe sensorineural hearing loss and intractable vertigo & tinnitus.
Removal of piston and labyrynthectomy relieved his tinnitus and vertigo.Stapedectomy FOr Hearing Loss Revision Stapes - "Long Piston" This patient underwent sta***tomy but resulted in dizziness. The prosthesis was larger and as a result (she was told by few consultants) it could not be replaced by a prosthesis of any size.
During a stapedectomy, an incision is made in the skin of the ear c***, the skin and eardrum are lifted to expose the stapes bone, and the stapes bone is removed. This video explains that the majority of people with hearing loss are good candidates for hearing aids. This starts after the tympanic membrane has been reflected forward and the middle ear work has been started.
Once the incudostapedial joint has been separated and stapes fixation has been established, the ND-Yag laser is used between 500 and 1000 milliwatts to section the stapedial tendon and the posterior stapedial crus. A small fenestra sta***tomy is performed centrally in the footplate and edges of the site are debrided with a Hough Hoe. An appropriately sized stapes piston is then inserted into the middle ear with piston end in the sta***tomy site and the hook wrapped around the incus. Anaesthesia can be either general (completely asleep), or local (the ear being anaesthesized with an injection) Further down the page you will find an indepth overview of stapedectomy.
We performed tympanotomy in the other area which revealed facial nerve on the foot plate hence further exploration is avoided due to the risk of sensorineural hearing loss.Capital Region Ear Institute Commercial The capital Rgion Ear Institute is a national recognized subspecialty referral center for the treatment of acoustic neuroma, hearing loss,and balance disorders.
We widened the fenestra which is also too small and adequate length piston placed.Hearing Aid Basics William Lippy, MD and Kathie Griffith, MA discuss hearing aid styles, technology, and maintenance. The stapes is the third of the three little hearing bones in the middle ear that transmit sound vibrations from the eardrum to the inner ear fluid so that we can hear. The endoscopic technique gives very good view, with excellent results and operation time is drastically reduced.
Sundharkrishnan has performes over a thousand endoscopic ear surgeries as well as demonstrated many times in live surgical ENT workshops.Sta***tomy Using Lumenis CO2 Laser Laser sta***tomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis.
The procedure creates a tiny opening in the stapes (the smallest bone in the human body) in which to secure a prosthetic. The CO2 laser allows the surgeon to create very small, precisely placed holes without increasing the temperature of the inner ear fluid by more than one degree, making this an extremely safe surgical solution. For more information, please visit .Otosclerose - Esta***tomia endoscopica - Otosclerosis - Endoscopic stapes surgery Video de esta***tomia totalmente enodoscopica em paciente com otosclerose e perda auditiva condutiva moderada. Note que nao ha necessidade de curetagem em parede posterior do conduto auditivo, o que deixa intocado o nervo corda do timpano. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results.
Teflon Causse protese (0,6 mm diametro x 6 mm comprimento) Totally endoscopic stapes surgery (stapedectomy) in patient with otosclerosis and moderate conductive hearing loss.
There is no need for curetting the auditory cannal posterior wall, leaving the chorda tympani untouched. A few of the advantages include improved audibility of sound, personal safety, and quality of life. See more at Left Stapedectomy - Dr Nirmal Patel Stapedectomy is the surgery performed for the condition called otosclerosis (a common cause of hearing loss in the younger patient). The surgery may be performed as a day surgery procedure, under local anaesthetic and involves no external cuts. For more information please visit Peri Lymph Gush during Stapes Surgery - Management Peri lymph gush during Stapedectomy is a rare complication of Stapes surgery. This video shows the situation of a patient with a peri lymp gush encountered during routine surgery. Ravi Ramalingam demonstrates how to seal the leak without any difficulty by placing gelfoam and successful sta***tomy in the opposite side.

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