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Otosclerosis and Stapes Surgery
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This segment provides examples of other middle ear pathology that may be encountered during stapes surgery.
Keywords
- Ossicular chain fixation
- Facial Nerve Dehiscence
- Stapes surgery
- Tympanic membrane
- Middle ear pathology
- Otosclerosis
Conflict of Interest
The authors declare that they have no conflict of interest.
References
- Vincent R, Sperling NM, Oates J, Jindal M (2006) Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with otology-neurotology database. Otol Neurotol 27(8 Suppl 2):S25–S47CrossRefGoogle Scholar
- Hughes GB (1991) The learning curve in stapes surgery. Laryngoscope 101(12 Pt 1):1280–1284CrossRefGoogle Scholar
- Kwok P, Gleich O, Dalles K, Mayr E, Jacob P, Strutz J (2017) How to avoid a learning curve in stapedotomy: a standardized surgical technique. Otol Neurotol 38(7):931–937CrossRefGoogle Scholar
- Hunter JB, Zuniga MG, Leite J, Killeen D, Wick C, Ramirez J, Rivas JA, Nogueira JF, Isaacson B, Rivas A (2016) Surgical and audiologic outcomes in endoscopic stapes surgery across 4 institutions. Otolaryngol Head Neck Surg 154(6):1093–1098CrossRefGoogle Scholar
- Iannella G, Magliulo G (2016) Endoscopic versus microscopic approach in stapes surgery: are operative times and learning curve important for making the choice? Otol Neurotol 37(9):1350–1357CrossRefGoogle Scholar
About this video
- Author(s)
- Cameron C. Wick
- First online
- 14 March 2019
- DOI
- https://doi.org/10.1007/978-3-030-16716-5_5
- Online ISBN
- 978-3-030-16716-5
- Publisher
- Springer, Cham
- Copyright information
- © The Author(s) 2019
Video Transcript
In the final segment, I would like to review some possible intraoperative findings that may be encountered when doing stapes surgery. Successful stapes surgery requires precision and a good understanding of the middle ear anatomy. Here are three scenarios that may alter your intraoperative decision making.
The first scenario highlights the importance of palpating the ossicular chain. The incus and the malleus should show mobility while the stapes should be fixed to confirm otosclerosis. Let’s go back to case number two. Here, palpating the malleus and then the incus shows intact mobility. Compare that to case number five where the malleus and the incus are fixed.
It is critical to recognize this fixation early. In this case, the incus and head of malleus were removed. The stapes turned out to be mobile. And the ossicular chain was reconstructed with a partial ossicular replacement prosthesis.
The next scenario to consider is a prolapsed facial nerve. Thankfully, injury to the facial nerve is exceedingly rare in stapes surgery. There are, however, anatomical variations that can put the nerve at risk.
Let’s take a look at case one. This is a left ear showing normal anatomy. There’s good visualization of the stapes foot plate. The tympanic segment of the facial nerve is not prolapsed and is not obstructing access to the foot plate.
Compare that to this case of a left ear in which the prolapsed facial nerve completely obstructs the stapes foot plate. Performing a stapedotomy in this scenario would put the nerve at risk. And therefore, the case is advised to be aborted.
The final scenario is a persistent stapedial artery. This is a congenital vascular anomaly. The stapedial artery, during development, arises from the second bronchial arch. It should involute but in certain situations, will persist.
If the artery is present, it’ll be seen coursing through the stapes superstructure. The presence of this artery may indicate abnormal intracranial vascularity. Therefore, it is typically advised to not coagulate this artery and to abort a stapedectomy if this is present.
This concludes the videos on otosclerosis, stapedotomy, stapedectomy, and some of the intraoperative findings that you may encounter during stapes surgery. My name is Cameron Wick. I hope you found this series educational and enjoyable.