Otoskleroz cerrahisinin işitme sonuçları üzerine etkinliğinin değerlendirilmesi

Amaç: Bu çalışmada hastaların otoskleroz cerrahisi sonrası işitme sonuçları ve işitsel başarı oranları değerlendirildi ve cerrahi komplikasyonları ve tedavileri irdelendi.Hastalar ve Yöntemler: Bu çalışmada Kocaeli Üniversitesi Kulak Burun Boğaz Anabilim Dalı’nda Mayıs 2002 - Nisan 2013 tarihleri arasında klinik otoskleroz tanısı konulan 100 hastanın iletim tipi işitme kaybı nedeniyle ameliyat edilen 115 kulağı retrospektif olarak incelendi. Hastaların işitme sonuçlarının başarısının değerlendirilmesinde ameliyat sonrası hava-kemik aralığı kullanıldı. Ameliyat sonrası hava-kemik aralığının 20 dB ve altında olması fonksiyonel başarı kriteri olarak alındı. Ameliyat sırasında ya da sonrasında ortaya çıkan komplikasyonlar kaydedildi.Bulgular: Ameliyat edilen 115 kulağın 105’inde %91.3 fonksiyonel başarı sağlandı. Piston çeşitlerine göre başarı oranları 0.6 mm’lik telli Teflon piston n=71 , floroplastik Teflon piston n=30 , K piston n=12 ve Easy piston n=2 grupları için sırasıyla %88.7, %93.3, %100 ve %100 olarak bulundu. Revizyon cerrahi altı hastaya %5.2 uygulandı.Sonuç: Çalışma bulgularımız, stapes cerrahisinin yüksek başarı ve düşük komplikasyon oranları ile otoskleroz tedavisinde başarılı ve güvenli bir tedavi yöntemi olduğunu göstermektedir

Evaluation of efficacy of otosclerosis surgery on hearing outcomes

Objectives: In this study we aimed to evaluate the audiologic results and audiologic success rates following otosclerosis surgery and to discuss surgical complications and their management. Patients and Methods: We retrospectively analyzed 115 ears of 100 patients who were diagnosed with clinical otosclerosis and operated at Kocaeli University, Faculty of Medicine, Department of Otolaryngology between May 2002 and April 2013. Postoperative air-bone gap was used in the evaluation of the success of the hearing results. The postoperative air-bone gap less than 20 dB was accepted as a success criterion. Intraoperative and postoperative complications were recorded. Results: Functional success was achieved in 105 of 115 operated ears 91.3% . Functional success rates according to types of piston for 0.6 mm wire Teflon piston n=71 , fluoroplastic Teflon piston n=30 , K piston n=12 and Easy piston n=2 groups were, 88.7%, 93.3%, 100%, and 100% respectively. Six patients 5.2% underwent revision surgery. Conclusion: Our study results suggest that stapes surgery is a successful and safe treatment modality with high success and low complication rates in the management of otosclerosis.

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  • Guild SR. Histologic otosclerosis. Ann Otol Rhinol Laryngol 1944;53:246-266.
  • Iyer PV, Gristwood RE. Histopathology of the stapes in otosclerosis. Pathology 1984;16:30-8.
  • Sakihara Y, Parving A. Clinical otosclerosis, prevalence estimates and spontaneous progress. Acta Otolaryngol 1999;119:468-72.
  • Bernardo MT, Dias J, Ribeiro D, Helena D, Condé A. Long term outcome of otosclerosis surgery. Braz J Otorhinolaryngol 2012;78:115-9.
  • Toynbee J. Diseases of the ear. Philadelphia: Blanchard and Lea; 1860.
  • Politzer A. Ueber primare Erkrankung der knochernen Labyrinthkapsel. Z Ohrenheilkd; 1893.
  • Causse JR, Causse JB. Otospongiosis as a genetic disease. Early detection, medical management, and prevention. Am J Otol 1984;5:211-23.
  • Hueb MM, Goycoolea MV, Paparella MM, Oliveira JA. Otosclerosis: the University of Minnesota temporal bone collection. Otolaryngol Head Neck Surg 1991;105:396-405.
  • Özüer MZ, Koç M. Otoskleroz cerahisi. Türkiye Klinikleri J E.N.T-Special Topics 2009;2:54-9.
  • Schuknecht HF, Applebaum EL. Surgery for hearing loss. N Engl J Med 1969;280:1154-60.
  • Denoyelle F, Daval M, Leboulanger N, Rousseau A, Roger G, Loundon N, et al. Stapedectomy in children: causes and surgical results in 35 cases. Arch Otolaryngol Head Neck Surg 2010;136:1005-8.
  • Maniu A, Cosgarea M. Technical and functional hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital. Eur Arch Otorhinolaryngol 2013;270:2215-24.
  • Berliner KI, Doyle KJ, Goldenberg RA. Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference? Am J Otol 1996;17:521-8.
  • Vincent R, Sperling NM, Oates J, Jindal M. Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database. Otol Neurotol 2006;27:S25-47.
  • Quaranta N, Besozzi G, Fallacara RA, Quaranta A. Air and bone conduction change after stapedotomy and partial stapedectomy for otosclerosis. Otolaryngol Head Neck Surg 2005;133:116-20.
  • Kisilevsky VE, Dutt SN, Bailie NA, Halik JJ. Hearing results of 1145 stapedotomies evaluated with Amsterdam hearing evaluation plots. J Laryngol Otol 2009;123:730-6.
  • de Bruijn AJ, Tange RA, Dreschler WA. Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. I. The effects of using different audiologic parameters and criteria on success rates. Otolaryngol Head Neck Surg 2001;124:76-83.
  • Kos MI, Montandon PB, Guyot JP. Short- and long- term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis. Ann Otol Rhinol Laryngol 2001;110:907-11.
  • Berliner KI, Doyle KJ, Goldenberg RA. Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference? Am J Otol 1996;17:214-20.
  • Banerjee A, Hawthorne MR, Flood LM, Martin FW. Audit of stapedectomy results in a district general hospital. Clin Otolaryngol Allied Sci 2002;27:275-8.
  • Smyth GD, Hassard TH. Eighteen years experience in stapedectomy. The case for the small fenestra operation. Ann Otol Rhinol Laryngol Suppl 1978;87:3-36.
  • McGee TM. Comparison of small fenestra and total stapedectomy. Ann Otol Rhinol Laryngol 1981;90:633-6.
  • Shea JJ. Stapedectomy - long-term report. Ann Otol Rhinol Laryngol 1982;91:516-20.
  • Persson P, Harder H, Magnuson B. Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy. Acta Otolaryngol 1997;117:94-9.
  • Spandow O, Söderberg O, Bohlin L. Long-term results in otosclerotic patients operated by stapedectomy or stapedotomy. Scand Audiol 2000;29:186-90.
  • Shabana YK, Ghonim MR, Pedersen CB. Stapedotomy: does prosthesis diameter affect outcome? Clin Otolaryngol Allied Sci 1999;24:91-4.
  • Sennaroğlu L, Unal OF, Sennaroğlu G, Gürsel B, Belgin E. Effect of teflon piston diameter on hearing result after stapedotomy. Otolaryngol Head Neck Surg 2001;124:279-81.
  • de Souza C, Glasscock ME. Otosclerosis and Stapedectomy. United States of America: Thieme Medical Publishers; 2004.
  • Sim JH, Chatzimichalis M, Röösli C, Laske RD, Huber AM. Objective assessment of stapedotomy surgery from round window motion measurement. Ear Hear 2012;33:e24-31.
  • Gristwood RE. Otosclerosis treatment. In: Alberti PW, Ruben RJ, editors. Otologic Medicine and Surgery. New York: Churchill Livingstone; 1988. p. 1241-59.
  • Donaldsan JA, Synder JM. Otosclerosis. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Schuller DE, editors. Otolaryngology-Head Neck Surgery. St. Louis: Mosby-Yearbook; 1992. p. 2997-3016.
  • Babighian GG, Albu S. Failures in stapedotomy for otosclerosis. Otolaryngol Head Neck Surg 2009;141:395-400.
  • Skinner M, Honrado C, Prasad M, Kent HN, Selesnick SH. The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping. Laryngoscope 2003;113:647-53.
  • Huber AM, Schrepfer T, Eiber A. Clinical evaluation of the NiTiBOND stapes prosthesis, an optimized shape memory alloy design. Otol Neurotol 2012;33:132-6.
  • House HP, Greenfield EC. Five-year study of wire loop-absorbable gelatin sponge technique. Arch Otolaryngol 1969;89:420-1.
  • Fayad JN, Semaan MT, Meier JC, House JW. Hearing results using the Smart piston prosthesis. Otol Neurotol 2009;30:1122-7.
  • Glasscock ME 3rd, Storper IS, Haynes DS, Bohrer PS. Twenty-five years of experience with stapedectomy. Laryngoscope 1995;105:899-904.
  • Wiet RJ, Battista RA, Wiet RM, Sabin AT. Hearing outcomes in stapes surgery: a comparison of fat, fascia, and vein tissue seals. Otolaryngol Head Neck Surg 2013;148:115-20.
  • Lopez A, Juberthie L, Olivier JC, Causse JB, Robinson J. Survival and evolution of vein grafts in otosclerosis surgery: structural and ultrastructural evidence. Am J Otol 1992;13:173-84.
  • Schmid P, Häusler R. Revision stapedectomy: an analysis of 201 operations. Otol Neurotol 2009;30:1092-100.
  • Gros A, Vatovec J, Zargi M, Jenko K. Success rate in revision stapes surgery for otosclerosis. Otol Neurotol 2005;26:1143-8.
  • Mandel L. Hyposalivation after undergoing stapedectomy. J Am Dent Assoc 2012;143:39-42.
  • Ceryan K, Gerbetçioğlu B. Otosklerozda odyolojik tanı. Türkiye Klinikleri J E.N.T-Special Topics 2009;2:12-9.
  • Ealy M, Schrauwen I, Van Camp G. Commentary on “Otosclerosis: thirty-year follow-up after surgery”. Ann Otol Rhinol Laryngol 2011;120:615-6.