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The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
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Stapes surgery in patients with a small air-bone gap
Jeremy Lavy1, Fiona McClenaghan
1Department of Otology, The Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Rd., London, WC1X8DA, UK.
Ear, Nose, & Throat Journal
|July 24, 2018
Summary
Stapes surgery effectively closes air-bone gaps (ABG) in patients with mild hearing loss. This procedure restores symmetrical hearing and can help patients avoid hearing aids.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Stapes surgery is a common treatment for otosclerosis and other forms of conductive hearing loss.
- Patients with smaller preoperative air-bone gaps (ABG) present unique challenges in stapes surgery.
- Optimizing hearing outcomes in this patient group is crucial for improving quality of life.
Purpose of the Study:
- To evaluate hearing outcomes after stapes surgery in patients with a preoperative air-bone gap (ABG) less than 21.25 dB.
- To assess the effectiveness of a nitinol fluoroplastic piston and laser-assisted technique in this specific patient cohort.
Main Methods:
- Retrospective analysis of 254 ears undergoing primary stapes surgery with ABG <21.25 dB over 15 years.
- Utilized a SMart 360 nitinol fluoroplastic piston for ossicular reconstruction and KTP laser for posterior crurotomy.
- Hearing outcomes assessed via immediate postoperative voice testing and 6-week pure-tone audiometry.
Main Results:
- Excellent ABG closure (<10 dB) achieved in 97.6% of cases.
- Bone-conduction thresholds improved in 44.9% of patients, remained stable in 29.1%, and decreased in 26.0%.
- Laser-assisted technique and surgical experience mitigated risks associated with small ABGs.
Conclusions:
- Stapes surgery is highly effective for closing ABGs in patients with mild conductive hearing loss.
- The procedure offers significant benefits, including hearing aid avoidance and restoration of symmetrical hearing.
- Careful surgical technique, including laser assistance, is vital for successful outcomes in this patient group.
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