Beware of a Fragile Footplate: Lessons from Ossiculoplasty in Patients with Ossicular Anomalies Related to Second Pharyngeal Arch Defects

Abstract

Background and objectives: We review the intraoperative findings and postoperative outcomes of ossiculoplasty in subjects with second pharyngeal arch (SPA)-derived ossicular anomalies. We summarize potential intraoperative complications and recommend precautions that may reduce the risk of fracture. Materials and Methods: Twenty-four patients with SPA-derived ossicular anomalies were included, and pre- and postoperative audiometric results were compared. Results: The mean air conduction threshold (56.0 ± 12.4 dB HL) was significantly improved 1 month (27.6 ± 10.1 dB HL) and 6 months (23.8 ± 13.2 dB HL) after surgery (p < 0.001). The preoperative air–bone gap (ABG) (40.4 ± 7.4 dB HL) was significantly decreased at 1 month (15.1 ± 5.9 dB HL) and 6 months (11.3 ± 8.9 dB HL) postoperation. ABG closure was successful (<20 dB HL) in 21 (87.5%) patients 6 months after surgery. Intraoperative footplate fractures occurred in 3 of 24 patients. The fractures were managed successfully, and the ABG closure was successful in all cases. Conclusions: The stapes footplate is likely to be relatively thin in subjects with SPA-derived ossicular anomalies because the footplate is partially or totally derived from the SPA. Thus, a fragile footplate should be expected, and care is needed when handling the footplate. However, when complications are overcome, the audiological outcomes are excellent in most cases.

Longitudinal analysis of surgical outcome in subjects with pulsatile tinnitus originating from the sigmoid sinus

“…At the initial visit, all patients underwent physical examination to identify any objective signs of PT (comprising head rotation to the ipsilateral and contralateral sides, digital compression of the ipsilateral internal jugular vein, and an otoendoscopic examination). All enrolled patients underwent audiometric evaluations including PTA, according to our reported protocols [37][38][39][40] . Pseudo-low frequency hearing loss (pseudo-LFHL) (an ipsilateral hearing threshold greater than 10 dB HL at both 250 and 500 Hz, or greater than 20 dB HL at either 250 or 500 Hz compared with the contralateral side) in the ipsilesional ear and its improvement after surgery were evaluated according to our previous report 17 .…”

Cortical Oscillatory Signatures Reveal the Prerequisites for Tinnitus Perception: A Comparison of Subjects With Sudden Sensorineural Hearing Loss With and Without Tinnitus

“…The hearing thresholds for seven different octave frequencies (0.25, 0.5, 1, 2, 3, 4, and 8 kHz) were evaluated using pure-tone audiometry in a soundproof booth. The mean hearing threshold was calculated using the average of the hearing thresholds at 0.5, 1, 2, and 4 kHz (Han et al, 2019;Shim et al, 2019;Bae et al, 2020;Huh et al, 2020;Lee et al, 2020b;Song et al, 2020). At each subject's initial visit, we obtained a structured history of the characteristics of tinnitus including its presence, laterality, and psychoacoustic nature (pure-tone or narrow-band noise).…”

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

“…The anterior vestibular artery, which supplies the labyrinth, is particularly vulnerable to ischemia because it lacks collateral vessels [30]. Thus, ischemic injury at a specific location induced by VBD compression, rather than compression per se, may trigger fluctuating, aggravating, or delayed audiovestibular symptoms [18,20,[31][32][33]. Therefore, in subjects with such symptoms, the possibility of vestibulocochlear nerve compression by VBD must be considered and thoroughly evaluated not only via brain or IAC MRI/MRA but also by performing a detailed neurotological examination.…”