Gusher in stapes surgery: a systematic review

Alicandri‐Ciufelli, Matteo; Molinari, Giulia; Rosa, Maria Silvia; Monzani, Daniele; Presutti, Livio

doi:10.1007/s00405-019-05538-x

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…In the 1960s, Lempart, Shambaugh, Wood, and Zangenmeister spoke critically about this theory. The results presented in 1995 by Pirodda et al of the analysis performed on a large group of 200 patients operated for otosclerosis during a follow-up period of 13.4 +/-5.3 years after surgery did not show any deterioration of bone conduction in the operated and non-operated ears [7,8].…”

Section: Discussionmentioning

confidence: 89%

Impact of surgery in otosclerosis on the non-operated ear

et al. 2020

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Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart's notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart's notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author's own studies by an average of 5 dB in the low-frequency range.

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Section: Discussionmentioning

confidence: 89%

Impact of surgery in otosclerosis on the non-operated ear

et al. 2020

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“…Moreover, the recommendation of pre-operative imaging in equivocal cases is even more compelling for young surgeons. This is because the interpretation of radiological findings is now essential for the training of young oto-surgeons, and also because a younger surgeon would have more difficulty managing a complication such as a gusher compared to an older surgeon with more experience [ 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Insidious Cases of Enlarged Vestibular Aqueduct (EVA) Syndrome Resembling Otosclerosis: Clinical Features for Differential Diagnosis and the Role of High-Resolution Computed Tomography in the Pre-Operative Setting

Motta,

Allosso,

Castagna

et al. 2024

Audiology Research

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Background: Enlarged vestibular aqueduct (EVA) syndrome can mimic otosclerosis in adults, presenting with an air–bone gap (ABG) and even absent stapedial reflexes. The ABG in inner-ear disorders is currently the object of several authors’ studies and seems to be related to a third mobile window (TMW) phenomenon. This can lead to misdiagnosis and inappropriate treatment. Given that it would be inappropriate and harmful to perform CT scans in all patients with a clinical diagnosis of otosclerosis, this study aims to highlight some clinical features useful for the differential diagnosis between otosclerosis and these rare cases of EVA presenting with an ABG, thus enabling the identification of suspected cases to be tested with CT scans. Methods: Between April and May 2024, a narrative review was conducted focusing on the differential diagnosis between some rare cases of EVA and otosclerosis. Clinical, audiological, and radiologic features of both conditions were investigated. Results: This review demonstrates the diagnostic challenge in differentiating atypical cases of EVA from otosclerosis in a subset of patients. Clinical and audiological features are important for differential diagnosis, but may not always be sufficient. Therefore, high-resolution computed tomography (HRCT) of the temporal bone plays a pivotal role in definitive diagnosis. Conclusions: In some specific cases, pre-operative imaging assessment using HRCT emerges as an essential tool for differentiating these two conditions and avoiding unnecessary stapes surgery.

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“… 32 Treatment for the patients varied: one patient's mild perilymphatic leak was managed by covering the oval window, while in the other, switching to the microscope was necessary to handle the gusher and fill the tympanic cavity with temporalis muscle. 33 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Findings on Facial Nerve Anatomy During Exclusive Endoscopic Stapedotomy: Clinical Considerations and Impact on Surgical Results

Soloperto,

Ronzani,

Sacchetto

et al. 2023

The Journal of International Advanced Otology

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Background: Variations along the facial nerve (FN) course present considerable challenges in the surgical treatment of otosclerosis, often complicating the procedure. Existing knowledge of its tympanic tract and its implications primarily comes from microscopical procedures. This study aims to assess endoscopic findings of FN anatomy in a healthy tympanic cavity and its impact on the stapedotomy procedure, focusing on the risk of complications and functional hearing outcomes. Methods: A retrospective study on exclusive endoscopic stapedotoplasties between October 2014 and October 2021 at our Otorhinolaryngology University Department was carried out. An evaluation of intraoperative endoscopic findings reviewed in surgical descriptive and/or video records was conducted to assess their potential negative impact on the surgery. Demographic data, preoperative and postoperative hearing thresholds, as well as intraoperative and postoperative complications were analyzed. Results: One hundred fifty-seven subjects were included. A FN partially overhanging the oval window was observed in 7.3% (n = 12): 10 prolapsing with bony canal dehiscence and 2 without any detected dehiscence. Each procedure was successfully completed without any issues related to the anomalous anatomy, and in no case, switching to the microscope for the handling of the prosthesis near the dehiscent nerve was required. No facial paralysis occurred, with an early- or long-term postoperative House–Brackman grade of 1 (n = 157, 100%). Only 3/157 patients (1.9%) showed a sensorineural threshold reduction of ≥20 dB HL, but a significant air–bone gap improvement was observed (mean closure of 18.36 dB HL, P < .0001). Conclusion: The endoscope promotes a concrete description of tympanic FN anatomy, and endoscopic stapes surgery appears to be a safe and viable option when dehiscent or prolapsed FNs reduce the footplate’s exposure.

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Gusher in stapes surgery: a systematic review

Cited by 12 publications

References 24 publications

Impact of surgery in otosclerosis on the non-operated ear

Impact of surgery in otosclerosis on the non-operated ear

Insidious Cases of Enlarged Vestibular Aqueduct (EVA) Syndrome Resembling Otosclerosis: Clinical Features for Differential Diagnosis and the Role of High-Resolution Computed Tomography in the Pre-Operative Setting

Endoscopic Findings on Facial Nerve Anatomy During Exclusive Endoscopic Stapedotomy: Clinical Considerations and Impact on Surgical Results

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