Cases reported "Otosclerosis"

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11/20. Surgical and prosthetic restoration of binaural hearing in an 88-year-old man.

    We report the restoration of binaural hearing in an 88-year-old man who was experiencing significant communication difficulties. His preoperative air conduction thresholds had revealed a pure-tone average of 55 dB for the left ear and 107 dB for the right, and he was dissatisfied with the benefits provided by his BICROS hearing aid arrangement that had been fitted to his left ear. The combined effects of surgery and a hearing aid offered a 70 to 80 dB improvement for his right ear and restored the communication advantages of binaural hearing.
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keywords = operative
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12/20. otosclerosis in a black child: diagnostic acoustic impedance studies.

    otosclerosis classically describes an osteodystrophic change in the bony labyrinth and stapes footplate, of autosomal dominant inheritance, reported rare under the age of 5, extremely "rare" in the Oriental and Black race, "non-existent" in the American Indian, and with a clinical incidence of 5 per 1000 Caucasians. The differential diagnosis of a non-effusion conductive hearing loss in a child should include otosclerosis, congenital malleus or footplate fixation, tympanosclerotic fixation, congenital cholesteatoma, lysis of the incus long process, Paget's disease, osteogenesis imperfecta, and fibromuscular hyperplasia of the renal artery. Presented is a case report of a 14-year-old black male with bilateral clinical otosclerosis and a persistent stapedial artery. Preoperative multiple-frequency tympanometry and Zwislocki acoustic reactance and resistance analysis demonstrated absence of the "W" resonance pattern on high-frequency tympanometry and the classic friction and stiffness patterns of otosclerotic fixation. Repeat multiple-frequency tympanometry testing post-stapedectomy demonstrated prosthesis articulation. Prosthesis position can be monitored postoperatively by these acoustic impedance studies.
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ranking = 2
keywords = operative
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13/20. Failures in surgery for stapedial otosclerosis.

    The causes for failure in surgery for stapedial otosclerosis are many. Most of these occur in the early postoperative period. Failures occurring later are due to either a breakdown of the reconstructed transformer system or to a labyrinthitis due to failure of the vestibular seal. The role of cochlear otospongiosis in producing late failures has not been sufficiently emphasized. This clinical review of 105 surgical failures examined consecutively during the years of 1975 through 1979 will demonstrate the importance of cochlear otospongiosis in this consideration. The fate of the unoperated-on ear in unilateral surgical failures will be demonstrated. Control of the progressive sensorineural hearing loss in these instances can be gained by the use of sodium fluoride therapy.
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ranking = 1
keywords = operative
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14/20. Sensorineural hearing loss in the unoperated-on otosclerotic ear.

    Severe sensorineural hearing loss occurs in less than 1% of stapedectomized ears. This low percentage remains as an irreducible minimum even among the most experienced and competent surgeons. The etiology has been hypothesized; however, the actual cause remains unknown. The rare occurrence of sensorineural hearing loss of undetermined etiology in the unoperated-on side was reported first in 1967 by Armstrong who presented a series of three patients. No other references have been found since this initial report. Recently three unilateral stapedectomized patients who developed sudden severe sensorineural hearing loss in the unoperated-on ear were studied during the years 1971 through 1979. The hearing loss occurred within 1 week, 6 weeks, and 12 years postoperatively. Although the number is small, a study of this group, in addition to Armstrong's, leads to several interesting considerations: 1. Is the incidence of sudden sensorineural type hearing loss greater, the same as, or less than that which develops in the non-otosclerotic general population? 2. Is there a possibility that the sudden sensorineural hearing loss of undetermined origin would occur at the time of surgery? Would this then be considered as a predisposing if not the actual etiology? The present series of six cases is so small that a conclusion is not possible and inference is only conjecture. It is hoped, however, that this may stimulate past, present, and future search for this unusual occurrence. This may help determine whether or not there is a causal or merely a coincidental relationship.
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keywords = operative
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15/20. Middle ear and inner ear effects on clinical bone-conduction threshold.

    The measurement of bone-conduction thresholds is an integral part of audiologic evaluation. The relationship between bone-conduction and air-conduction thresholds is the differentiating diagnostic indicator between conductive and sensorineural hearing loss. At the same time, the influence of middle ear and inner ear structures upon the bone-conduction response has been well documented. We present two cases illustrating this influence and attempt to explain the clinical bone-conduction thresholds with operative findings.
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keywords = operative
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16/20. Far-advanced otosclerosis.

    Profound deafness has received increasing attention in recent years, largely because of the availability of cochlear implants. Consequently, it is especially important for otolaryngologists to remember that a "blank" audiogram does not necessarily mean total or even profound deafness. patients with far-advanced otosclerosis may have no measurable hearing with routine audiometric testing even in the presence of serviceable sensorineural hearing. review of nine patients (10 ears) who underwent stapedectomy from 1980 to 1987 reveals that seven of the nine (78%), who had been unable to use a hearing aid preoperatively, obtained serviceable hearing with hearing aids following surgery. Otolaryngologists should depend on a good history and tuning fork examination to avoid being misled by the audiogram, and should not hesitate to offer stapes surgery to patients with far-advanced otosclerosis.
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ranking = 1
keywords = operative
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17/20. endolymphatic hydrops associated with otosclerosis.

    endolymphatic hydrops (EH) associated with otosclerosis has been noted for many years. However, the causal relationship of these two entities remains controversial. Having reviewed the records of patients with otosclerosis describing fluctuant hearing loss and vertiginous symptoms, the authors found the EH may coexist with otosclerosis preoperatively; they may be two separate diseases that exist coincidentally; or EH may be caused by the otosclerotic process. Secondly, EH may occur with a fistula after surgery. Occurring after stapedectomy, EH may be caused by fistulization of the bony labyrinth, which is effectively treated by surgery to seal the fistula, which may cause EH to subside and hearing to improve. Thirdly, delayed EH may occur months or years after stapedectomy, possibly as a result of otosclerotic foci or surgical insult to the labyrinth. dexamethasone, diuretics, and a room air rebreather can be used in the treatment of delayed EH. Hearing may be maintained or may deteriorate, but there usually is no dizziness. The clinical manifestations of EH associated with otosclerosis include a conductive or mixed type of hearing loss; the presence of fullness, tinnitus, fluctuation of hearing, episodic vertigo, an elevated negative summating potential (SP), and an increased summating potential:action potential (SP:AP) ratio shown by ECoG. This report presents five cases of EH associated with otosclerosis.
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ranking = 1
keywords = operative
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18/20. MRI and clinical decisions in cochlear implantation.

    High-resolution computed tomography (HRCT) is the standard imaging technique used in cochlear implantation. However, cochlear and retrocochlear soft-tissue abnormalities may not be detected with HRCT alone. To determine whether magnetic resonance imaging (MRI) provides clinically significant information in addition to HRCT in the evaluation of candidates for cochlear implants, we performed a prospective study of 13 consecutive patients with cochlear implant patients receiving preoperative, high-resolution fast spin-echo T2-weighted MRI scans of the temporal bone. MRI identified unanticipated cochlear fibrosis in one patient, vestibular schwannoma in one patient, patency in the second turn of the cochlea in a patient with labyrinthitis ossificans, and disproved cochlear fibrosis suspected on HRCT imaging in one patient. These findings were significant for clinical decisions regarding candidacy for surgery, side selection for surgery, and surgical technique in cochlear implantation. Our experience suggests a high-resolution T2-weighted MRI of the temporal bone should be used preoperatively in addition to HRCT before cochlear implantation.
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ranking = 2
keywords = operative
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19/20. Variant petrotympanic fissure as possible cause of an otologic complication during TMJ arthroscopy. A case report.

    In this reported case, a variant petrotympanic fissure--opening at the height of the orifice of the eustachian tube into the hypotympanon--was identified by high resolution computed tomography (CT) as the possible cause of a tympanic membrane perforation. Inner ear function was preserved by an otosclerotic stapes which prevented destruction of the labyrinth. The perforation was closed by a myringoplasty and was to be followed by a stapedectomy after six months to restore normal hearing. Surgeons performing temporomandibular joint arthroscopy should be aware that in a small percentage of patients a variant anatomy of the tympanic plate exists and, therefore, great care must be exercised in the manipulation of instruments near this structure. A preoperative high resolution CT with thin slices of the temporal bone might allow identification of these high risk patients.
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ranking = 1
keywords = operative
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20/20. The knotted wire in stapes surgery: one possible factor in postoperative sensori-neural hearing loss.

    In four instances of revision stapedectomy in patients with sensori-neural hearing loss, with or without dizziness, a wire prosthesis was found with an extention beyond the knot which could impinge on the contents of the vestibule. Four commercially manufactured knotted wire prostheses were examined, and the end of three was found projecting beyond the knot. The wire piercing the membranous labyrinth appears to be one of the factors in causing further sensori-neural hearing loss after stapedectomy. A wire loop or piston prosthesis should be considered to eliminate the hazard of a trailing end of a knotted wire in stapes surgery.
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ranking = 4
keywords = operative
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