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Assessment of the ability of the radiological incudo-stapedial angle to predict the stapedotomy technique type: a prospective case-series study

  • Otology
  • Published:
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Abstract

Purpose

This study aimed to propose a radiological classification of the incudo-stapedial angle by preoperative high-resolution computed tomography (HRCT) images and to highlight its importance for predicting the use of reversal-steps stapedotomy (RSS) rather than the traditional non-reversal technique.

Methods

We included 83 candidates for stapedotomy operation. Two physicians measured the radiological incudo-stapedial joint angle in the preoperative HRCT. According to this measurement, the radiological incudo-stapedial joint was classified into three types: obtuse, right, and acute. In addition, this radiological classification was correlated with the intraoperative use of the stapedotomy technique, either reversal or non-reversal.

Results

The RSS technique was used in forty-two (97.7%) cases with an obtuse angle and twenty-six (89.7%) with a right angle. At the same time, the traditional non-reversal technique was used in all patients with an acute angle. The three groups differed significantly regarding the method used for stapedotomy (P value < 0.001). Moreover, Spearman’s correlation coefficient revealed a significant correlation between the used technique and the radiological type of the incudo-stapedial angle (P value < 0.001).

Conclusions

This prospective study proposed a preoperative radiological classification of the incudo-stapedial angle. This classification was significantly correlated with the type of stapedotomy technique. The RSS technique was feasible in most cases with an obtuse and right radiological incudo-stapedial angle. In contrast, the non-reversal method was used in all patients with an acute radiological incudo-stapedial angle. This radiological classification could predict the choice for the stapedotomy technique with an accuracy of 95.18%, a sensitivity of 73.33%, and a specificity of 100%.

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Data availability

The data presented in this study are available on request from the corresponding author.

References

  1. Covelli E, Elfarargy HH, Filippi C, Margani V, Volpini L, Barbara M (2022) Thulium laser in stapedotomy surgery. Acta Otolaryngol 142(3–4):234–240. https://doi.org/10.1080/00016489.2022.2048071

    Article  PubMed  Google Scholar 

  2. Gołabek W, Szymański M, Siwiec H, Morshed K (2003) Incus subluxation and luxation during stapedectomy. Annales Universitatis Mariae Curie-Sklodowska Section D Medicina 58(1):302–305

    Google Scholar 

  3. Wiet RJ, Harvey SA, Bauer GP (1993) Complications in stapes surgery. Options for prevention and management. Otolaryngol Clin N Am 26(3):471–490

    Article  CAS  Google Scholar 

  4. Fisch U (2009) Stapedotomy versus stapedectomy. Otol Neurotol 30(8):1160–1165. https://doi.org/10.1097/MAO.0b013e3181c1792d

    Article  PubMed  Google Scholar 

  5. Malafronte G, Filosa B (2009) Fisch’s reversal steps stapedotomy: when to use it? Otol Neurotol 30(8):1128–1130. https://doi.org/10.1097/MAO.0b013e3181be686e

    Article  PubMed  Google Scholar 

  6. Kösling S, Plontke SK, Bartel S (2020) Imaging of otosclerosis. Bildgebung der Otosklerose. RoFo 192(8):745–753. https://doi.org/10.1055/a-1131-7980

    Article  PubMed  Google Scholar 

  7. Dudau C, Salim F, Jiang D, Connor SE (2017) Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis. Eur Radiol 27(3):1195–1201. https://doi.org/10.1007/s00330-016-4446-8

    Article  PubMed  Google Scholar 

  8. Purohit B, Hermans R, Op de Beeck K (2014) Imaging in otosclerosis: a pictorial review. Insights Imaging 5(2):245–252. https://doi.org/10.1007/s13244-014-0313-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kösling S, Woldag K, Meister EF, Reschke I, Heywang-Köbrunner SH (1995) Value of computed tomography in patients with persistent vertigo after stapes surgery. Invest Radiol 30(12):712–715. https://doi.org/10.1097/00004424-199512000-00004

    Article  PubMed  Google Scholar 

  10. Singh A, Irugu D, Kumar R, Verma H (2019) A review of surgical nuances and outcomes of the reverse stapedotomy. J Int Adv Otol 15(1):151–155. https://doi.org/10.5152/iao.2019.6800

    Article  PubMed  PubMed Central  Google Scholar 

  11. Skinner M, Honrado C, Prasad M, Kent HN, Selesnick SH (2003) The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping. Laryngoscope 113(4):647–653. https://doi.org/10.1097/00005537-200304000-00012

    Article  PubMed  Google Scholar 

  12. Singh A, Irugu D, Kumar R, Verma H, Gupta A, Kumari A (2020) Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization. J Otol 15(2):50–53. https://doi.org/10.1016/j.joto.2019.09.004

    Article  PubMed  Google Scholar 

  13. Fang Y, Zhang K, Ren LJ, Lamb JJ, Hong R, Shu Y, Chen B (2021) Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes? Eur Arch Oto-Rhino-Laryngol 278(3):645–652. https://doi.org/10.1007/s00405-020-06103-7

    Article  Google Scholar 

  14. Malafronte G, Filosa B, Cantone E (2008) New macroscopic classification of stapedio-ovalar otosclerosis: a simplified rating for training in stapedotomy. Otol Neurotol 29(7):889–892. https://doi.org/10.1097/MAO.0b013e31818201de

    Article  PubMed  Google Scholar 

  15. Lang EE, Waheed K, Colreavy M, Burns H (2004) A retrospective review of stapes surgery following introduction of “reversal of the steps” technique. Clin Otolaryngol Allied Sci 29(6):571–573. https://doi.org/10.1111/j.1365-2273.2004.00863.x

    Article  CAS  PubMed  Google Scholar 

  16. Ueda H, Kishimoto M, Uchida Y, Sone M (2013) Factors affecting fenestration of the footplate in stapes surgery: effectiveness of Fisch’s reversal steps stapedotomy. Otol Neurotol 34(9):1576–1580. https://doi.org/10.1097/MAO.0b013e3182a473eb

    Article  PubMed  Google Scholar 

  17. Pedersen CB (1987) The use of a small fenestra technique with the Fisch piston in the surgical treatment of otosclerosis. J Laryngol Otol 101(6):542–547. https://doi.org/10.1017/s0022215100102208

    Article  CAS  PubMed  Google Scholar 

  18. Szymański M, Gołabek W, Morshed K, Siwiec H (2007) The influence of the sequence of surgical steps on complications rate in stapedotomy. Otol Neurotol 28(2):152–156. https://doi.org/10.1097/01.mao.0000247815.23948.89

    Article  PubMed  Google Scholar 

  19. Barbara M, Lazzarino A, Mure C, Macri C, Volpini L, Monini S (2011) Laser versus drill-assisted stapedotomy for the treatment of otosclerosis: a randomized-controlled trial. J Int Adv Otol 7:283–288

    Google Scholar 

  20. Anson BJ, Hanson JS, Richany SF (1960) Early embryology of the auditory ossicles and associated structures in relation to certain anomalies observed clinically. Ann Otol Rhinol Laryngol 69:427–447. https://doi.org/10.1177/000348946006900212

    Article  CAS  PubMed  Google Scholar 

  21. Rodríguez-Vázquez JF, Yamamoto M, Kim JH, Jin ZW, Katori Y, Murakami G (2020) The incudopetrosal joint of the human middle ear: a transient morphology in fetuses. J Anat 237(1):176–187. https://doi.org/10.1111/joa.13181

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors have no budget or financial relationships to disclose.

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Authors and Affiliations

  1. Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

    Maurizio Barbara, Edoardo Covelli & Valerio Margani

  2. Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh University Hospital, El-Geish Street, Kafrelsheikh, 33155, Egypt

    Saad Elzayat, Hussein A. El-Shirbeny & Haitham H. Elfarargy

  3. Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohammed Abdelbadie Salem

  4. Radiology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

    Ahmed I. Ebeed

  5. Otolaryngology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Luigi Volpini

Authors
  1. Maurizio Barbara
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  2. Saad Elzayat
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  3. Hussein A. El-Shirbeny
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  4. Mohammed Abdelbadie Salem
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  5. Ahmed I. Ebeed
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  6. Edoardo Covelli
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  7. Luigi Volpini
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  8. Valerio Margani
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  9. Haitham H. Elfarargy
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Contributions

MB designed the work. SE acquired and analyzed data. HAE acquired and analyzed data. MAS acquired and analyzed data. AIE acquired and analyzed data. EC drafted, revised, and approved the manuscript. LV drafted, revised, approved the manuscript. VM drafted, revised, approved the manuscript. HHE agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hussein A. El-Shirbeny.

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Barbara, M., Elzayat, S., El-Shirbeny, H.A. et al. Assessment of the ability of the radiological incudo-stapedial angle to predict the stapedotomy technique type: a prospective case-series study. Eur Arch Otorhinolaryngol 280, 4879–4884 (2023). https://doi.org/10.1007/s00405-023-08008-7

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