John M. Burkey

Twenty-year review of revision stapedectomy

Objective To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies. Study Design Retrospective chart review. Setting Tertiary otologic referral center. Patients A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz. Results Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB. Conclusions More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.

Ossiculoplasty in canal wall down mastoidectomy

OBJECTIVE: The aim of this study was to evaluate the initial and longer term success of closing the air-bone gap (ABG) to 20 dB in ossiculoplasty with canal wall down mastoidectomy. METHODS: This study was conducted at a private otologic practice. Patients included those who underwent ossiculoplasty from 1989 to 1996 with canal wall down mastoidectomy, whether primary or revision (33 from a total of 387 tympanomastoidectomies). Outcome measures included ABG closure, long-term hearing stability, mastoid appearance, extrusion, and sensorineural hearing loss. RESULTS: Almost 64% of ABGs were closed to within 20 dB. The mean pure-tone average improvement was 12.3 dB. The mean PTA hearing decline in the years after surgery was slightly less than 1 dB/year. CONCLUSION: Hearing improvement with a stable long-term hearing result is possible with canal wall down mastoidectomy. The potential for hearing gain is greatest for patients having larger preoperative ABGs. (Otolaryngol Head Neck Surg 2000;123: 30-3.)

Does Pregnancy Affect Otosclerosis

Objective: To evaluate the effect of pregnancy on the hearing of women with otosclerosis.

Short- and long-term results of stapedectomy in children.

Studies have indicated that stapedectomy can be an effective procedure in children for correcting conductive hearing losses due to juvenile otosclerosis. However, because childhood otosclerosis is rare and children commonly choose to use hearing aids in lieu of undergoing surgery, little outcome data are available. The purpose of this retrospective study was to provide additional outcome data in both the short and the long term. Stapedectomies were performed on 47 children. Preoperative hearing results were compared with 6‐month postoperative hearing results. Hearing results for the children who had long‐term follow‐up (5 years or more) were compared with the 6‐month postoperative results. Stapedectomy was successful (postoperative air conduction pure‐tone average [PTA] within 10 dB of the preoperative bone conduction PTA) in 91.7% of the cases. The mean over‐closure of the preoperative bone conduction PTA by the postoperative air conduction PTA was 0.2 dB. The mean PTA hearing improvement was 32.8 dB. Results from the 21 children (28 ears) who had long‐term follow‐up indicated an average 0.7 dB/year PTA worsening from the 6‐month postoperative PTA. Results from this study provide additional evidence that stapedectomy can be an effective procedure for correcting conductive hearing losses due to juvenile otosclerosis.

Otosclerosis in the 1960s, 1970s, 1980s, and 1990s

Educational Objective: The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years.

Stapedectomy in Patients With Small Air-Bone Gaps

Controversy exists concerning stapedectomy for patients with small air‐bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air‐bone gap. One hundred fifty‐four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure‐tone average (PTA) improved 16.7 dB and overclosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overclosing even small air‐bone gaps due to otosclerosis.

COCHLEAR IMPLANTATION IN THE VERY YOUNG CHILD

Children younger than 2 years of age were initially excluded from cochlear implant candidacy for a variety of reasons. Reasons ranged from concerns about the reliability of the diagnosis of a profound hearing loss in very young children, to concerns about surgical safety and long-term durability of the device in a growing child. Results from several recent studies have shown that children younger than 2 years of age can safely and successfully be implanted. Provided this success, and the general agreement that early remediation of a hearing loss provides a greater potential for speech and language development, implantation of very young children may soon become the norm rather than the exception. This article discusses the issues related to the implantation of young children and the need for special tools and protocols to use with this population.

Acoustic Reflexes, Auditory Brainstem Response, and MRI in the Evaluation of Acoustic Neuromas

Patient records were reviewed to determine whether persons with absent acoustic reflexes have a higher incidence of abnormal auditory brainstem response (ABR) results in the absence of a cerebellopontine angle (CPA) tumor than those with normal acoustic reflexes. Results showed patients with absent reflexes to have borderline or abnormal ABR results in 45.2% of the cases. Patients with normal reflexes had borderline or abnormal ABR results in 14.2% of the cases. Results indicate that magnetic resonance imaging is a more appropriate test for patients with absent reflexes, since ABR was often nondiagnostic for a CPA tumor in this group.

Comparison of titanium and Robinson stainless steel stapes piston prostheses.

Objective: Although stainless steel stapes prostheses have generally been considered magnetic resonance imaging safe, there is concern that this may change with the development of more powerful imaging systems. The objective of the study was to determine whether a titanium piston stapes prosthesis would be audiometrically and surgically equivalent to a Robinson stainless steel piston for stapedectomy. Study Design: Retrospective chart review. Setting: Private otology practice. Patients: In all, 50 patients underwent stapedectomy with a Gyrus titanium piston prosthesis. These patients were matched on the basis of age and preoperative bone-conduction scores with patients who underwent stapedectomy with a Robinson stainless steel piston prosthesis. Main Outcome Measures: Audiometric results are analyzed, and surgical complications noted. Results: There was no significant difference between groups in hearing improvement or postoperative air-bone gap. The mean four-frequency hearing improvement was 27.7 dB for the stainless steel group and 27.8 dB for the titanium group. The mean postoperative air-bone gap was 2.65 dB for the stainless steel group and 2.60 for the titanium group. Neither group had a surgical complication. Conclusion: The titanium stapes prosthesis is a good alternative to a stainless steel prosthesis.

Latent demand for the bone-anchored hearing aid: the Lippy Group experience.

Objective: The usefulness of the bone-anchored hearing aid (BAHA) for conductive and mixed hearing losses and recently for single-sided deafness has been well documented. Less clear is the number of patients who might benefit from the BAHA and how many would be interested in having the surgery. The purpose of this investigation is to examine these latter issues from the perspective of an otology practice. Study Design: Retrospective review. Setting: Private otology practice. Patients: Approximately 44,000 patient records were reviewed. On the basis of this review, 617 patients were sent a letter describing the BAHA and explaining that they might be candidates. One hundred sixty-two of these patients made an appointment to be evaluated for the BAHA. Methods: Patients who responded to the BAHA letter underwent an otologic and audiological evaluation to confirm their candidacy. The BAHA surgery and device were described, and interested patients tried the BAHA test band in the office. Patient responses to the BAHA were noted. Results: Approximately 1.4% of the cases reviewed (617/44,000) were considered to be potential BAHA candidates. One hundred forty-six of the 162 patients who scheduled a BAHA evaluation were confirmed to be candidates. After seeing and learning about the BAHA, 92% of the verified candidates wanted to try the BAHA test band. Most patients who tried the test band (92%) liked the BAHA, and nearly a third (30.6%) had BAHA surgery. Patients with conductive or mixed hearing loss who tried the test band were more likely to have BAHA surgery than those with single-sided deafness (45.8% versus 27.3%). The major limiting factor was infrequent or inadequate insurance coverage for the procedure or device. Conclusions: Although the percentage of patients in an otology practice who could benefit from the BAHA is small, finding and alerting potential BAHA candidates are worthwhile.