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Long-term hearing in revision stapedectomy for incus erosion
Otolaryngology Head and Neck Surgery
Scientific Sessions- - Tuesday
Volume 115 Number 2
P 103
8:08 AM
graded "satisfactory" if closure of the air-bone gap to within 10 dB was achieved. Results with closure greater than 10 dB were graded "unsatisfactory." Results: Overall closure of the air-bone gap to within 10 dB was achieved in 87% of cases. High-frequency senserineural hearing loss of 15 to 30 dB occurred in three cases. No "dead ears" were noted in this series. Satisfactory hearing results for local versus general anesthesia were not statistically significant (local, 87%; general, 88%). Conclusion: Stapedotomy performed by residents is safe and successful if performed under optimal conditions. We believe that close supervision and use of the operating laser, small fenestra technique, and general anesthesia are important keys to successful resident training and good surgical outcome.
Long-Term Hearing In Revision Stapedectomy for Incus Erosion
8:24 AM
cant for both the patients with sudden SNHL and the "ruleout AN" patients. With low-probability patients, FSE-MRI was cost comparable to traditional evaluation with better sensitivity and specificity. Conclusions: In an era of medical economic scrutiny with constant pressure to become more cost-effective, FSE-MRI has become the most cost-effective method to screen for retrocochlear pathology by improving existing technology while reducing the cost of providing that technology. FSEMRI will likely replace ABR and Gado-MRI in the evaluation of acoustic tumor suspects as costs continue to be reduced. The implications of nonspecialty utilization will be discussed.
LAWRENCE W. KRIEGER, MD (presenter), WILLIAM H. UPPY, MD, ARNOLD G. SCHURING, MD, and FRANKLIN M. RIZER, Sarasota, Fla., and Warren, Ohio
Discussion
Objectives: One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported to be successful in 70% to 80% of patients at 1 year. Little has been written about long-term results or the association of erosion with various prostheses. Methods: Eighty-three cases were evaluated from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was done under local anesthesia using the Lippy modified prosthesis. Results: Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none were worse. At 10 years success declined to 50% (7/14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21123), dropping to 86% at I0 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24/70), a plastic strut in 23%, and a Robinson prosthesis in 17%. Conclusions: The risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis gives good long-term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.
The Multichannel Auditory Brain Stem Implant Clinical Trial
8:16 AM
Stapes Surgery in a Teaching Hospital SHAWN B. MATHEWS, MD (presenter), BARRY M. RASGON, MD, and FREDERICK BYL, MD, Oakland, Calif.
Objective: Stapes surgery is a technically challenging undertaking, particularly in inexperienced hands. We review our results for stapes procedures performed by residents and offer suggested techniques that we believe improve surgical outcomes. Methods: Seventy-one cases of stapedotomy performed by residents were reviewed for hearing results, complications, operative time, and anesthetic type. The results were
8:30 AM
STEVEN R. OTFO, MA (presenter), DERALD E. BRACKMANN, MD, WILLIAM E. HITSELBERGER,MD, STEVEN STALLER, PhD, CHRISTINE MENAPACE, MA, and ROBERTV. SHANNON, PhD, Los Angeles, Calif., and Englewood, Colo.
Objective: The multichannel auditory brain stem implant (ABI) was developed in 1992 for use in patients who are not appropriate candidates for conventional amplification or cochlear implantation. A multisite clinical trial was initiated to evaluate the safety and effectiveness of the ABI. Methods: Since June 1994, the ABI has been implanted in 38 patients diagnosed with neurofibromatosis type II at six investigational sites. An extensive postoperative evaluation was used to assess patient performance with the device. Patients were evaluated at the time of initial device stimulation, at 3-month intervals during the first year, and annually thereafter. A battery of speech perception tests and psychophysical measures were obtained at every interval. Results: Currently, 87% of patients implanted with the ABI are able to use the device. Ninety-two percent of these patients demonstrate improvement in speech perception when the ABI is used in conjunction with lipreading. Five patients also obtained significant levels of open-set sentence recognition in the auditory-only condition. Conclusions: The multichannel ABI appears to be a safe and effective treatment for persons without viable auditory nerves who cannot benefit from cochlear implantation. 8:38 AM
Vestibular Ablation in the Older Patient ALAN W. LANGMAN, MD (presenter), Seattle, Wash.
Objective: Ablation of vestibular function is a highly efficacious option in the treatment of disabling vertigo that
Scientific Sessions- - Tuesday
Volume 115 Number 2
P 103
8:08 AM
graded "satisfactory" if closure of the air-bone gap to within 10 dB was achieved. Results with closure greater than 10 dB were graded "unsatisfactory." Results: Overall closure of the air-bone gap to within 10 dB was achieved in 87% of cases. High-frequency senserineural hearing loss of 15 to 30 dB occurred in three cases. No "dead ears" were noted in this series. Satisfactory hearing results for local versus general anesthesia were not statistically significant (local, 87%; general, 88%). Conclusion: Stapedotomy performed by residents is safe and successful if performed under optimal conditions. We believe that close supervision and use of the operating laser, small fenestra technique, and general anesthesia are important keys to successful resident training and good surgical outcome.
Long-Term Hearing In Revision Stapedectomy for Incus Erosion
8:24 AM
cant for both the patients with sudden SNHL and the "ruleout AN" patients. With low-probability patients, FSE-MRI was cost comparable to traditional evaluation with better sensitivity and specificity. Conclusions: In an era of medical economic scrutiny with constant pressure to become more cost-effective, FSE-MRI has become the most cost-effective method to screen for retrocochlear pathology by improving existing technology while reducing the cost of providing that technology. FSEMRI will likely replace ABR and Gado-MRI in the evaluation of acoustic tumor suspects as costs continue to be reduced. The implications of nonspecialty utilization will be discussed.
LAWRENCE W. KRIEGER, MD (presenter), WILLIAM H. UPPY, MD, ARNOLD G. SCHURING, MD, and FRANKLIN M. RIZER, Sarasota, Fla., and Warren, Ohio
Discussion
Objectives: One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported to be successful in 70% to 80% of patients at 1 year. Little has been written about long-term results or the association of erosion with various prostheses. Methods: Eighty-three cases were evaluated from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was done under local anesthesia using the Lippy modified prosthesis. Results: Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none were worse. At 10 years success declined to 50% (7/14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21123), dropping to 86% at I0 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24/70), a plastic strut in 23%, and a Robinson prosthesis in 17%. Conclusions: The risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis gives good long-term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.
The Multichannel Auditory Brain Stem Implant Clinical Trial
8:16 AM
Stapes Surgery in a Teaching Hospital SHAWN B. MATHEWS, MD (presenter), BARRY M. RASGON, MD, and FREDERICK BYL, MD, Oakland, Calif.
Objective: Stapes surgery is a technically challenging undertaking, particularly in inexperienced hands. We review our results for stapes procedures performed by residents and offer suggested techniques that we believe improve surgical outcomes. Methods: Seventy-one cases of stapedotomy performed by residents were reviewed for hearing results, complications, operative time, and anesthetic type. The results were
8:30 AM
STEVEN R. OTFO, MA (presenter), DERALD E. BRACKMANN, MD, WILLIAM E. HITSELBERGER,MD, STEVEN STALLER, PhD, CHRISTINE MENAPACE, MA, and ROBERTV. SHANNON, PhD, Los Angeles, Calif., and Englewood, Colo.
Objective: The multichannel auditory brain stem implant (ABI) was developed in 1992 for use in patients who are not appropriate candidates for conventional amplification or cochlear implantation. A multisite clinical trial was initiated to evaluate the safety and effectiveness of the ABI. Methods: Since June 1994, the ABI has been implanted in 38 patients diagnosed with neurofibromatosis type II at six investigational sites. An extensive postoperative evaluation was used to assess patient performance with the device. Patients were evaluated at the time of initial device stimulation, at 3-month intervals during the first year, and annually thereafter. A battery of speech perception tests and psychophysical measures were obtained at every interval. Results: Currently, 87% of patients implanted with the ABI are able to use the device. Ninety-two percent of these patients demonstrate improvement in speech perception when the ABI is used in conjunction with lipreading. Five patients also obtained significant levels of open-set sentence recognition in the auditory-only condition. Conclusions: The multichannel ABI appears to be a safe and effective treatment for persons without viable auditory nerves who cannot benefit from cochlear implantation. 8:38 AM
Vestibular Ablation in the Older Patient ALAN W. LANGMAN, MD (presenter), Seattle, Wash.
Objective: Ablation of vestibular function is a highly efficacious option in the treatment of disabling vertigo that