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The Microscopic Transcanal Approach in Stapes Surgery Revisited
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Persistent stapedial artery with stapes ankylosis.
Hisashi Sugimoto1, Makoto Ito2, Miyako Hatano1
1Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Auris, Nasus, Larynx
|September 8, 2014
Summary
Persistent stapedial artery (PSA), a rare vascular anomaly, can cause hearing loss. This study shows malleus-stapedotomy without coagulating the PSA can successfully improve hearing in patients with otosclerosis and PSA.
Area of Science:
- Otolaryngology
- Vascular Anomalies
- Surgical Innovation
Background:
- The persistent stapedial artery (PSA) is a rare congenital vascular anomaly presenting as a pulsatile middle ear mass, potentially causing conductive hearing loss.
- Diagnosis is often incidental due to its rarity and difficulty in prediction. CT findings may include absence of the foramen spinosum and soft-tissue prominence near the facial nerve.
Observation:
- A case of PSA with stapes ankylosis is presented, treated with malleus-stapedotomy using a Teflon wire piston without coagulating the PSA.
- Despite the prosthesis attaching to the PSA, the patient experienced significant hearing improvement and resolution of tinnitus.
Findings:
- Attachment of the prosthesis to the PSA does not necessarily impede hearing improvement after malleus-stapedotomy for otosclerosis.
- This case demonstrates a successful surgical approach for otosclerosis with coexisting PSA, preserving the artery.
Implications:
- Many cases of otosclerosis with PSA can be effectively treated with stapedotomy using a prosthesis without coagulating the persistent stapedial artery.
- This approach may reduce surgical risks associated with PSA coagulation, such as facial palsy or hemiplegia.
