Labyrinthotomy or Vestibulotomy in Anatomic and Congenital Variations of the Oval Window and Facial Nerve

Abstract

Objective: To present the results of our experience with labyrinthotomy or vestibulotomy in cases where the oval window is blocked by the facial nerve and in the presence of bilateral congenital agenesis of the oval window, respectively. Study design: Retrospective analysis of the records of the patients operated in two different centers. Methods: Between 2007 and 2012, 5 ears of 4 patients who were operated on in two different clinics with a presumptive diagnosis of otosclerosis were included in the study. There were 3 female patients and 1 male. The ages ranged from 10 to 26 (mean 19 years). All patients had unilateral conductive hearing loss except 1 (10-year-old girl or patient 1). Pure tone averages were calculated at the frequencies 0.5, 1, 2 and 4 kHz both pre- and postoperatively according to the Committee on Hearing and Equilibrium 1995 Guidelines for the Evaluation of Results of Treatment of Conductive Hearing Loss. All patients underwent a middle ear exploration and postoperatively the initial audiological examination was performed after 6 months. Results: Retrospective analysis revealed that vestibulotomy or labyrinthotomy was performed in 5 ears of 4 patients. Postoperative dizziness was encountered in 2 patients who had vestibulotomy due to oval window agenesis, which ceased spontaneously at 1 month postoperatively. The perioperative period was otherwise uneventful. None of the patients had sensorineural hearing loss or deterioration of hearing. There was a significant improvement in hearing after the operation. A 28-dB improvement in the mean air conduction pure tone thresholds was achieved. Conclusion: Vestibulotomy and labyrinthotomy are safe and effective procedures in terms of hearing restoration, which can be applied in cases of congenital agenesis of the oval window or obstruction of the oval window by the facial nerve.

Oval window atresia with inferiorly located facial nerve: Successfully use of alternative fenestration site of cochleostomy for ossicular chain reconstruction

“…A straight Teflon piston modified by reducing the circular portion (0.6 mm in diameter and 4.0 mm in length) [6] was used between the new window and the malleus. In our case, we made the window immediately above the round window, so the staight piston is unsuitable beause of the angle; also, the preferred length of the Piston was different .Al-Mazrou and the colleagues [7] reported three cases of labyrinthotomy under the facial nerve and achieved good long-term functional recovery; the straight prosthesis with 4.5 mm in length was used between incus and the new window in all these three cases because of the intact malleus and incus, no specific fenestration site was mentioned in the article. Liu and colleagues [8] reported ossicular chain reconstruction with TORP (the total ossicular replacement prosthesis) using a scala tympani drill-out technique in 3 patients, and achieved >25dB hearing improvement in 2 patients.…”

A Novel Way of Stimulation of the Inner Ear via Labyrinthotomy with Fully Implantable Active Middle Ear Implant, Carina

“…Vestibulotomy or labyrinthotomy is a surgical option for prosthesis placement in the absence or closure of the oval window [9] . Similarly, in the present case, the inner ear was stimulated through the endosteum of the otic capsule in the area corresponding to the round window.…”

Reporting and Description for Congenital Middle Ear Malformations to Facilitate Surgical Management

“…Table 2 shows that 129 patients exhibited aberrant facial nerves. These aberrant facial nerves usually were exposed at the upper rim of the oval window or at the middle or lower edge of the promontory, or bifurcated at the upper and lower edges, 42,43 or the surface, of the stapes. One hundred seventy-two patients (91.0%) exhibited a deformed stapes suprastructure, including missing anterior and posterior arches and slim or deformed masses.…”