Stellenwert der CT-Diagnostik vor Revisions-Stapedotomien

Abstract

BACKGROUND: Stapedectomy and, more recently, stapedotomy have been widely accepted as the primary surgical techniques to improve conductive hearing in patients suffering from otosclerosis. Unsuccessful outcomes are infrequent, but revision surgery may become necessary. We have analyzed the value of computed tomography (CT) scanning following unsuccessful stapes surgery. PATIENTS AND METHODS: In a total of 37 CT scans, the depth of insertion, angle between prosthesis and footplate, location of prosthesis within the oval niche, visibility of the prosthesis, dehiscence of the superior semicircular canal, and extent of otospongiotic foci were evaluated and compared with the audiometric results. RESULTS: There was no significant correlation between CT parameters and audiologic results, except for patients with cochlear otosclerosis or lateral dislocation of the piston. One previously unknown dehiscence of the superior semicircular canal was diagnosed. Otospongiotic foci were seen in 13 ears (35%). CONCLUSION: Displacements of the stapes piston and rare causes for an insufficient result, such as a dehiscence of the superior semicircular canal, can be diagnosed accurately by CT. However, correlation between the audiologic results and the findings on CT scans was possible in only a few cases. Nevertheless, CT scans provide additional information for surgical planning in revision stapes surgery and may become increasingly important to reduce unanticipated intraoperative risks; they may even guide the surgeon not to perform unnecessary revision surgeries.

Radiological Control of the Floating Mass Transducer Attached to the Round Window

“…Postoperative radiological control is helpful to improve the quality of the surgical approach, to monitor the audiological outcome, and to be able to decide which revisions may be required after cochlear implantation and stapes surgery [10–12]. Although the radiological resolution has improved and increased with the advent of new technologies (e.g., 64-MSCT, flat-panel tomography, and digital volume tomography), it has been shown that there is a difference between temporal bone measurements and radiological estimations.…”

“…Postoperative, radiological evaluation of the position of otological implants is a useful tool for quality control, for example, in cochlear implantation [10] and stapes surgery [11, 12]. It is important for the clinical outcome, for making decisions about surgical revisions, and for optimizing the surgical technique.…”

Surgery of the ear and the lateral skull base: pitfalls and complications

“…HRCT of the temporal bone is a useful tool in the decision-making process concerning stapes revision [147], especially if conductive hearing loss persists after primary surgery. In these cases, HRCT is able to detect additional pathologies of the temporal bone which may account for the persistent hearing loss, e.g.…”