Long-term results of the use of autogenous cortical bone columellas to replace the stapes at stapedectomy

Abstract

The first author has been using an autogenous cortical bone columella to replace the stapes removed during stapedectomy since 1965. The audiograms of 21 of the 271 patients operated on with this method between 1965 and 1989 (i.e. 7.7% of the possible candidates) were available 20-35 (average 26.8) years postoperatively. The operation could be regarded as successful in 20 and unsuccessful in 1 patient in the long run. The audiological data are presented individually as averages of the values obtained at 0.5, 1, 2 and 3 kHz. The averaged data (n = 21): preoperative air conduction, 58.27; bone conduction, 24.46; and air-bone gap, 33.81 dB. Postoperative best air conduction, 19.07; bone conduction, 14.10; and air-bone gap, 4.97 dB. Postoperative recent air conduction, 45.77; bone conduction, 38.45; and air-bone gap, 7.32 dB. The best values were measured 1-8 (average 1.57) years postoperatively. In relation to the postoperative best value, the recent value of the air-bone gap had deteriorated by 2.35 dB, and that of the bone conduction by 24.35 dB. The small air-bone gap indicates that the deterioration of the hearing is mainly caused by the deterioration of the function of the inner ear and not by that of the conductive apparatus. The progression of the deterioration differs individually (0.3-1.6, average 0.93 dB/year) and accelerates with age. This finding seems to be a problem that does not depend on the operative technique. The data show that the autogenous bone columella ensures the same good and lasting results as the alloplastic solutions; moreover, there is no problem with the incus-prosthesis connection.

Posztoperatív vertigo vizsgálata stapedotomián és stapedectomián átesett betegeknél

“…Szédüléses panaszok tekintetében nem volt szignifikáns különbség a vizsgált két csoport között (OR: 2,20; CI: 0, [17][18][19][20][21][22][23][24][25][26][27][28]14). Az álta-lunk vizsgált 24 betegből 7 betegnek voltak preoperatív szédüléses panaszai (29%).…”

“…Mindkét műtéti megoldás jó audioló-giai eredménnyel jár [15][16][17]. Klinikánk azon ritka inté-zetek egyike, ahol egy időszakban mindkét műtéttípust rutinszerűen végeztük, így lehetőség nyílt a műtétek kö-vetkezményeinek összehasonlítására [18][19][20].…”

Reporting in stapes surgery: are we following the guidelines?

“…The ABG closure was calculated using the four-tone average for pre- and post-operative air conduction and bone conduction thresholds in 86.3 per cent of the papers; 4 , 6 , 7 , 14 – 21 , 23 – 53 , 55 , 59 , 62 however, 3 kHz was only used in 45.1 per cent of these calculations 6 , 7 , 15 , 16 , 20 , 21 , 24 , 28 , 32 – 34 , 38 , 40 – 44 , 47 , 51 , 53 , 55 , 57 , 59 . The remaining papers either substituted 3 kHz with 4 kHz (in 79.2 of papers), or averaged 2 kHz and 4 kHz (in 16.7 per cent).…”

“…In those papers that reported the ABG closure correctly, only 11.8 per cent reported the mean, SD and range of their results 6 , 19 , 22 , 29 , 42 , 44 , 51 . A one-year follow-up audiogram was conducted in only 60.1 per cent of studies 7 , 14 – 16 , 19 , 21 , 23 , 25 , 27 , 29 – 31 , 33 , 36 – 39 , 41 – 45 , 47 , 50 , 51 , 55 , 57 , 59 – 61 Non-adherence to current guidelines can lead to over-inflated reports of successful air–bone gap closureThis can affect the consent process and patient expectationsClear guidelines exist for reporting otological surgery outcomesNevertheless, incorrect reporting continues and minimal datasets are still missingAdherence to guidelines provides accurate outcomes and inter-study comparisons…”

Az otoscleroticus eredetű hallócsontláncolati fixatiók klinikuma

“…A fasciával befedett foramen ovale és az incus hosszú szára közé helyezett csontdarabokat (két rövid típusú columella, vagyis PORP) ionomer cementtel összeragasztva áthidalható a csonthiány. Ezzel a technikával is megfelelő hosszú távú eredmények érhetők el [42,45].…”