Authors:
Imre Gerlinger Medical School, University of Pécs Department of Oto-rhino-laryngology & Head and Neck Surgery Munkácsy M. u. 2 H-7621 Pécs Hungary

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Péter Bakó Medical School, University of Pécs Department of Oto-rhino-laryngology & Head and Neck Surgery Munkácsy M. u. 2 H-7621 Pécs Hungary

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Krisztina Somogyvári Medical School, University of Pécs Department of Oto-rhino-laryngology & Head and Neck Surgery Munkácsy M. u. 2 H-7621 Pécs Hungary

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Péter Móricz Medical School, University of Pécs Department of Oto-rhino-laryngology & Head and Neck Surgery Munkácsy M. u. 2 H-7621 Pécs Hungary

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József Pytel Medical School, University of Pécs Department of Oto-rhino-laryngology & Head and Neck Surgery Munkácsy M. u. 2 H-7621 Pécs Hungary

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Introduction: Development of surgical treatment of otosclerotic stapes fixation is one of the success stories of otology during the past five decades. Nowadays not only stapedectomy and partial stapedectomy but stapedotomy can also be considered a well-established otological procedure. Aim: To introduce this minimally invasive surgical technique into the Hungarian otolaryngology practice, to gain useful experiences, and to analyze the hearing improvements and postoperative complications. Methods: The authors give account of their first clinical experiences with 14 patients with KTP laser assisted stapedotomies using the self-crimping Nitinol piston. A total of 14 patients (11 females, 3 males) who have undergone the procedure between March 2006 and April 2007 were reviewed. The average age of the patients was 42.2 years, 6 procedures were carried out on left ears and 8 on right ones. The average length of follow-up was 9 months (ranging from 6 weeks to 1 year). Results: Pure tone audiograms documented a hearing threshold improvement of 21.5 dB averaged across 0.5–1–2–3 kHz frequencies. The air-bone gap improvement averaged on the same frequencies was 18.7 dB. After an average 9 months postoperative follow-up period, the average air-bone gap was < 10 dB in 85% of the patients, however < 20 dB in 100% of the patients. As for the average air conduction result: it was < 30 dB in each patient except one. In this series, neither facial nerve paresis nor high frequency deterioration of the bone conduction thresholds was reported in the postoperative follow-up period. Conclusions: Based on the authors’ favourable experiences and the review of the literature, KTP laser assisted stapedotomy with the use of Nitinol piston has several advantages: 1. the laser-activated memory effect of the piston prevents the disadvantages of the crimping manouvre made around the long process of the incus; 2. vertigo, experienced in the early postoperative period is milder and takes shorter time, reducing the length of hospitalisation; 3. the procedure is cost-effective and minimally-invasive; 4. application of KTP laser assures a bloodless operating field and minimal cochlear trauma; 5. migration of the prosthesis can be prevented, the degree of the surrounding granulation is less; 6. high frequency hearing improvement can be achieved on the long run; 7. the frequency and seriousness of complications are less, therefore this technique can be reccommended for unexperienced ear surgeons too; 8. the procedure can be used in difficult situations, too, e.g. in the presence of stapedial artery, obliterative otosclerosis, floating footplate, abnormal position of the facial nerve in the middle ear, revision cases; 9. the interindividual differences of hearing results are much less. Based on their favourable initial experiences, the authors plan to conduct a long-term follow-up on a greater number of patients.

  • Shea, J. J.: Fenestration of the oval window. Ann. Otol. Rhinol. Laryngol., 1958, 67 , 932–951.

    Shea J. J. , 'Fenestration of the oval window ' (1958 ) 67 Ann. Otol. Rhinol. Laryngol. : 932 -951 .

    • Search Google Scholar
  • Rosen, S.: Simple method for restoring hearing in otosclerosis. Acta Otolaryngol., 1954, 44 , 78–88.

    Rosen S. , 'Simple method for restoring hearing in otosclerosis ' (1954 ) 44 Acta Otolaryngol. : 78 -88 .

    • Search Google Scholar
  • Lempert, J.: Improvement of hearing in cases of otosclerosis: a new one-stage surgical technique. Arch. Otolaryngol., 1938, 28 , 42–97.

    Lempert J. , 'Improvement of hearing in cases of otosclerosis: a new one-stage surgical technique ' (1938 ) 28 Arch. Otolaryngol. : 42 -97 .

    • Search Google Scholar
  • Vernick, D.: A comparation of the results of KTP and CO 2 laser stapedotomy. Am. J. Otol., 1996, 17 , 221–224.

    Vernick D. , 'A comparation of the results of KTP and CO2 laser stapedotomy ' (1996 ) 17 Am. J. Otol. : 221 -224 .

    • Search Google Scholar
  • Bauer, M.: Reoperations after stapes operations (In Hungarian). Fül-orr-gégegyógy., 1997, 43 , 227–243.

    Bauer M. , 'Reoperations after stapes operations (In Hungarian) ' (1997 ) 43 Fül-orr-gégegyógy. : 227 -243 .

    • Search Google Scholar
  • Jóri, J., Kiss, J. G., Czigner, J.: Changes of acustic impedance after stapedectory and stapedotomy (In Hungarian). Fül-orr-gégegyógy., 1993, 39 , 17–21.

    Czigner J. , 'Changes of acustic impedance after stapedectory and stapedotomy (In Hungarian) ' (1993 ) 39 Fül-orr-gégegyógy. : 17 -21 .

    • Search Google Scholar
  • Ribári, O.: Possibilities of the surgical improvement of hearing. In: Káldor, A., Gergely, J., Kulka, F. (eds): Actual Problems in Medicine, vol. 43. (In Hungarian) Medicina Könyvkiadó, Budapest, 1982, 121–131.

    Ribári O. , '', in Actual Problems in Medicine, vol. 43 (In Hungarian) , (1982 ) -.

  • Plester, D.: Fortschritte in der Microchirurgie des Ohres in den letzen 10 Jahren. HNO, 1970, 18 , 33–40.

    Plester D. , 'Fortschritte in der Microchirurgie des Ohres in den letzen 10 Jahren ' (1970 ) 18 HNO : 33 -40 .

    • Search Google Scholar
  • Häusler, R.: Advances in stapes surgery. In: Jahnke, K.: Middle ear surgery. Recent advances and future directions. Thieme, Stuttgart–New York. 2004, pp. 95–133.

    Häusler R. , '', in Middle ear surgery. Recent advances and future directions , (2004 ) -.

  • Shea, J. J.: A personal history of stapedectomy. Am. J. Otol., 1998, 19 (Suppl. 5) , S2–S12.

    Shea J. J. , 'A personal history of stapedectomy ' (1998 ) 19 Am. J. Otol. : S2 -S12 .

  • Di Bartolomeo, J. R.: The argon laser in otology. Laryngoscope, 1980, 90 , 1786–1796.

    Bartolomeo J. R. , 'The argon laser in otology ' (1980 ) 90 Laryngoscope : 1786 -1796 .

    • Search Google Scholar
  • Perkins, R. L.: Laser stapedotomy for otosclerosis. Laryngoscope, 1980, 90 , 228–241.

    Perkins R. L. , 'Laser stapedotomy for otosclerosis ' (1980 ) 90 Laryngoscope : 228 -241 .

    • Search Google Scholar
  • Lesinski, S. G., Stein, J. A.: Stapedectomy revision with CO 2 laser. Laryngoscope, 1989, 99 , 13–19.

    Stein J. A. , 'Stapedectomy revision with CO2 laser ' (1989 ) 99 Laryngoscope : 13 -19 .

    • Search Google Scholar
  • Nagel, D.: The Er: YAG laser in ear surgery: first clinical results. Lasers Surg. Med., 1997, 21 , 79–87.

    Nagel D. , 'The Er: YAG laser in ear surgery: first clinical results ' (1997 ) 21 Lasers Surg. Med. : 79 -87 .

    • Search Google Scholar
  • Bartels, L.: KTP laser stapedotomy: is it safe? Otolaryngol. Head Neck Surg., 1990, 103 , 685–692.

    Bartels L. , 'KTP laser stapedotomy: is it safe? ' (1990 ) 103 Otolaryngol. Head Neck Surg. : 685 -692 .

    • Search Google Scholar
  • Gerlinger I., Pytel J.: KTP-laser assisted tympanoplasty. Oto-rhino-laryngologia Nova (Basel), 2001, 11 , 157–161.

    Pytel J. , 'KTP-laser assisted tympanoplasty ' (2001 ) 11 Oto-rhino-laryngologia Nova (Basel) : 157 -161 .

    • Search Google Scholar
  • Häusler, R., Schar, P. J., Pratisto, H. et al.: Advantages and dangers of Erbium laser application in stapedotomy. Acta Otolaryngol., 1999, 119 , 207–213.

    Pratisto H. , 'Advantages and dangers of Erbium laser application in stapedotomy ' (1999 ) 119 Acta Otolaryngol. : 207 -213 .

    • Search Google Scholar
  • Jovanovic, S., Schonfeld, U., Scherer, H.: CO 2 laser stapedotomy with the “one-shot” technique – clinical results. Otolaryngol. Head Neck Surg., 2004, 131 , 750–757.

    Scherer H. , 'CO2 laser stapedotomy with the “one-shot” technique – clinical results ' (2004 ) 131 Otolaryngol. Head Neck Surg. : 750 -757 .

    • Search Google Scholar
  • Knox, G. W., Reitan, H.: Shape-memory tapes prosthesis for otosclerosis surgery. Laryngoscope, 2005, 115 , 1340–1347.

    Reitan H. , 'Shape-memory tapes prosthesis for otosclerosis surgery ' (2005 ) 115 Laryngoscope : 1340 -1347 .

    • Search Google Scholar
  • Ryhaenen, J., Niemi, E., Serlo, W. et al.: Biocompatibility of nickel-titanium shape memory metal and its corrosion behavior in human cell cultures. J. Biomed. Mat. Res., 1997, 35 , 451–457.

    Serlo W. , 'Biocompatibility of nickel-titanium shape memory metal and its corrosion behavior in human cell cultures ' (1997 ) 35 J. Biomed. Mat. Res. : 451 -457 .

    • Search Google Scholar
  • Kasano, F., Morimitsu, T.: Utilization of nickel-titanium shape memory alloy for stapes prosthesis. Auris Nasus Larynx, 1997, 24 , 137–142.

    Morimitsu T. , 'Utilization of nickel-titanium shape memory alloy for stapes prosthesis ' (1997 ) 24 Auris Nasus Larynx : 137 -142 .

    • Search Google Scholar
  • Rajan, G. P., Atlas, M., Subramaniam, K. et al.: Eliminating the limitations of manual crimping in stapes surgery? A preliminary trial with the shape memory Nitinol stapes piston. Laryngoscope, 2005, 115 , 366–369.

    Subramaniam K. , 'Eliminating the limitations of manual crimping in stapes surgery? A preliminary trial with the shape memory Nitinol stapes piston ' (2005 ) 115 Laryngoscope : 366 -369 .

    • Search Google Scholar
  • American Academy of Ophthalmology & Otolaryngology, Head and Neck Surgery: Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol. Head Neck Surg., 1995, 113 , 186–187.

    'Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss ' (1995 ) 113 Otolaryngol. Head Neck Surg. : 186 -187 .

    • Search Google Scholar
  • Lang, E. E., Waheed, K., Colreavy, M. et al.: A retrospective review of stapes surgery following introduction of “reversal of the steps” technique. Clin. Otol., 2004, 29 , 571–573.

    Colreavy M. , 'A retrospective review of stapes surgery following introduction of “reversal of the steps” technique ' (2004 ) 29 Clin. Otol. : 571 -573 .

    • Search Google Scholar
  • Farrior, J., Sutherland, A.: Revision stapes surgery. Laryngoscope, 1991, 101 , 1155–1161.

    Sutherland A. , 'Revision stapes surgery ' (1991 ) 101 Laryngoscope : 1155 -1161 .

  • Huber, A. M., Ma, F., Felix, H. et al.: Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery. Laryngoscope, 2003, 113 , 853–858.

    Felix H. , 'Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery ' (2003 ) 113 Laryngoscope : 853 -858 .

    • Search Google Scholar
  • Blayney, A. W., Williams, K. R., Rice, H. J.: A dynamic and harmonic damped finite element analysis model of stapedotomy. Acta Otolaryngol., 1997, 117 , 269–273.

    Rice H. J. , 'A dynamic and harmonic damped finite element analysis model of stapedotomy ' (1997 ) 117 Acta Otolaryngol. : 269 -273 .

    • Search Google Scholar
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Hungarian Medical Journal
Language English
Size  
Year of
Foundation
2007
Publication
Programme
ceased
Volumes
per Year
 
Issues
per Year
 
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 1788-6139 (Print)
ISSN 1789-0403 (Online)