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Stapedectomy

Stapedectomies


Presentation

  • OBJECTIVE: To compare presentation, operative findings, and outcomes among pediatric patients undergoing primary stapedectomy for congenital stapes footplate fixation (CSFF) and juvenile otosclerosis (JO). STUDY DESIGN: Retrospective review.[ncbi.nlm.nih.gov]
  • A 45-year-old male patient presented with vertigo after Valsalva maneuver 12 years after stapedectomy.[ncbi.nlm.nih.gov]
  • Otalgia was present in all our cases, and may be deemed a red flag symptom of progressive bony destruction and otic capsule involvement.[ncbi.nlm.nih.gov]
  • We discuss the patient's presenting condition, operative course, and our diagnostic and management strategy in this case.[ncbi.nlm.nih.gov]
  • The history, physical, and laboratory findings are presented.[ncbi.nlm.nih.gov]
Falling
  • If the prosthesis is attached to loose, it may fall off. If it is attached and the incus sustains too much trauma, the incus may die and the prosthesis will fall off.[entusa.com]
  • However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz; poorer results are typically obtained in the high frequencies, but these are normally less hampered by otosclerosis in the first place.[en.wikipedia.org]
  • After almost 20yrs, I can say with authority that I fall into the latter category. There was no mention of tinitus pre surgery. I went into the surgery with great expectations and left with tinitus.[tinnitustalk.com]
  • The patient must be protected from falls and self-injury until the sense of balance is regained.[medical-dictionary.thefreedictionary.com]
  • During laser or mechanical stapedotomy, bone fragments may become mobile and fall into the vestibule, which may increase the chances of postoperative vertigo.[emedicine.medscape.com]
Asymptomatic
  • Despite the fact that the prosthesis remains unfixed in the scala vestibuli at the basal turn of the cochlea, the patient has remained nearly asymptomatic in his right ear for approximately 2 years.[ncbi.nlm.nih.gov]
Suggestibility
  • CT showed extensive demineralization of the otic capsule, suggestive of otospongiotic change in both ears. There were no hyperostotic lesions found, which would have been suggestive of otosclerotic change.[ncbi.nlm.nih.gov]
  • An alternative name, 'Stapes surgery induced granulation tissue' (SSIG) is therefore suggested for this condition.[ncbi.nlm.nih.gov]
  • Patients who had poor hearing outcomes reported abolition of their tinnitus, suggesting that this was due to the improvement in the fluid mechanics of the cochlea resulting from stapedectomy.[ncbi.nlm.nih.gov]
  • This information suggests that the formation of cartilage from perichondrium in the oval window might be influenced by mechanical trauma and tissue orientation.[ncbi.nlm.nih.gov]
  • These cases also suggest that full flight status can be reinstated as soon as 3 months after stapedectomy without endangering flight safety.[ncbi.nlm.nih.gov]
Dizziness
  • Symptoms may include various degrees of hearing loss, tinnitus and dizziness.[ncbi.nlm.nih.gov]
  • Ten patients with far advanced otosclerosis or dizziness were then excluded. Closure of air-bone gap to within 10 dB was achieved in 67.6% of patients. Pure tone average (PTA, 500-4,000 Hz) improvement in hearing was 22.5 dB.[ncbi.nlm.nih.gov]
  • Complications Nausea and dizziness: this is common and expected after surgery and is usually mild and short lived. Many medications are given to prevent these and only a few patients feel dizzy beyond the day of surgery.[earassociates.com]
  • Although some patients feel slight unsteadiness, call our office if you have severe dizziness, ringing or other problems.[dupagemedicalgroup.com]
  • Some dizziness, nausea and vomiting are normal for three days after surgery. If the dizziness becomes severe, call the office. It is normal to experience mild dizziness when moving your head for several weeks after surgery.[drpeterfriedland.com.au]
Vertigo
  • Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.[ncbi.nlm.nih.gov]
  • Post-operatively, she developed persistent symptoms of benign paroxysmal positional vertigo (BPPV). Eight weeks later, a canalith repositioning procedure was performed in the office, with immediate complete resolution of her vertigo.[ncbi.nlm.nih.gov]
  • One year after surgical treatment the subject was free of vertigo spells. Pathogenetic mechanisms are discussed.[ncbi.nlm.nih.gov]
  • A 45-year-old male patient presented with vertigo after Valsalva maneuver 12 years after stapedectomy.[ncbi.nlm.nih.gov]
  • The postoperative vertigo duration after stapedotomies was significantly shorter than that after stapedectomies. CONCLUSIONS: Surgery-induced sensorineural hearing losses were similar for stapedotomies and stapedectomies.[ncbi.nlm.nih.gov]
Meningism
  • Meningitis following stapedectomy occurring in the immediate postoperative period has not been previously described.[ncbi.nlm.nih.gov]
  • Post-operative complications included grade IV facial weakness and late Pseudomonas aeruginosa meningitis, which all resolved. To the authors' knowledge, this paper reports the only case of post-stapedectomy granuloma tracking to the brainstem.[ncbi.nlm.nih.gov]
  • Meningitis following stapedectomy. Laryngoscope 78, 56–63, 1968. PubMed CrossRef Google Scholar 11. CAUSSE J., CAUSSE J.B. Eighteen years report on stapedectomy. Problems of stapedial fixation. Clin. Otol 5, 49, 1980. CrossRef Google Scholar 12.[link.springer.com]
  • Rarely, facial paralysis and meningitis (a brain infection) can occur.[entusa.com]
  • […] commonly implicated substances implanted within the middle ear causing their development. [12] Serous or suppurative labyrinthitis Another uncommon complication is suppurative labyrinthitis or other surgical site infection such as acute otitis media or meningitis[emedicine.medscape.com]
Ataxia
  • A 66 year old woman had light-headedness and ataxia which increased slowly despite tissue seal of a post-stapedectomy oval window fistula. The cause was shown to be a large acoustic neuroma, ipsilateral to the side of the fistula.[ncbi.nlm.nih.gov]
Irritability
  • Mechanical irritation of the facial or chorda nerve during operation may trigger the activation. The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.[ncbi.nlm.nih.gov]

Treatment

  • METHODS: Otolaryngologists in community practice were provided with written surveys pertaining to their treatment of otosclerosis.[ncbi.nlm.nih.gov]
  • We stress the uncommon coincidence of the two events and the important implications in the treatment of a palsy appearing after middle ear surgery.[ncbi.nlm.nih.gov]
  • One year after surgical treatment the subject was free of vertigo spells. Pathogenetic mechanisms are discussed.[ncbi.nlm.nih.gov]
  • The incidence, treatment and prognosis of this complication are discussed.[ncbi.nlm.nih.gov]
  • The site aims to answer some of the questions you may have about otosclerosis and outline the treatment options.[stapedectomy.co.uk]

Prognosis

  • The incidence, management and prognosis of such injuries are discussed.[ncbi.nlm.nih.gov]
  • The incidence, treatment and prognosis of this complication are discussed.[ncbi.nlm.nih.gov]
  • Pathology 6 Clinical Picture 7 Differential Diagnosis 7 Investigations 7 Treatment 8 CHAPTER 3 Stapedectomy 9 Historical View 9 Indications and Patient Selection 10 Contraindications 11 The Technique 11 Anatomical Variation 14 Post- operative care 15 Prognosis[scribd.com]
  • Types of stapedectomy failure and prognosis of revision operations. J. Laryngology & Otology 88 (3) 213–226, 1974. Google Scholar 2. SMYTH G.D., HASSARD T.H. Eighteen years experience in stapedectomy. T.e case for the small fenestra operation. Ann.[link.springer.com]

Etiology

  • The etiology of poststapedectomy cholesteatoma in this patient was probably chronic eustachian tube dysfunction and negative middle ear pressures.[ncbi.nlm.nih.gov]
  • Age, gender, pre- and postoperative audiograms, intraoperative findings including etiology of stapes fixation, prosthesis type, and complications were recorded.[ncbi.nlm.nih.gov]
  • Sherif Magdi Sanad OTOSCLEROSIS AND STAPEDECTOMY The E x pect ed C omplic ations 2006 Sherif Magdi Sanad T able o f C ont ent s CHAPTER 1 Anatom y of the Ear 1 The External Ear 1 The Middle Ear 2 The Inner Eat 3 CHAPTER 2 Otosclerosis 5 Incidence 5 Etiology[scribd.com]
  • CONCLUSIONS: Stapedectomy may be regarded as an etiological factor in BPPV. Because the fenestra is located in the posterior part of the stapes footplate, the pathophysiology appears to be related to utricular rather than saccular trauma.[ncbi.nlm.nih.gov]
  • Dazert, Current aspects of etiology, diagnosis and therapy of otosclerosis, Otolaryngologia Polska, 65, 3, (162), (2011).[doi.org]

Epidemiology

  • RECENT FINDINGS: The epidemiology of clinical otosclerosis appears be changing. The average age for patients undergoing primary stapes surgery is increasing, and the percentage of revision stapedectomies is increasing.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Because the fenestra is located in the posterior part of the stapes footplate, the pathophysiology appears to be related to utricular rather than saccular trauma.[ncbi.nlm.nih.gov]
  • Anatomic and pathophysiologic implications of these observations will be discussed.[ncbi.nlm.nih.gov]
  • The pathophysiology of so-called 'reparative granuloma' occurring after stapedectomy has not been determined and universally accepted management of this rare complication has not yet been established.[ncbi.nlm.nih.gov]

Prevention

  • The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.[ncbi.nlm.nih.gov]
  • The bucket handle of the prosthesis is rotated over the incus to prevent the prosthesis from slipping.[ghorayeb.com]
  • We will provide you with antibiotics to help prevent infection. Your ear will feel especially sensitive immediately following your procedure.[cosmeticsurgerywv.com]
  • Swimming may be limited during the first few weeks to prevent getting water into the ear. Home care will also be required to prevent putting too much pressure on the healing stapes.[winchesterhospital.org]
  • Post-op Care After surgery, the patient stays in bed in the hospital for a few hours to prevent nausea and vomiting.[earassociates.com]

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