Novosti
Khirurgii
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Year 2012 Vol. 20 No 2

OTORHINOLORYNGOLOGY

EL-REFAI HUSAM 1, V.P. SITNIKOV 1, T.I. KOLESNIK 2

RESTAPEDOPLASTY AFTER OPERATIONS BECAUSE OF OTOSCLEROSIS

EE Gomel State Medical University 1,
ME Gomel regional specialized clinical hospital 2,
The Republic of Belarus

Objectives. To improve the restapedoplasty efficiency in patients with otosclerosis.
Methods. During the period of 2008-2011 the analysis of the intraoperative findings in 24 patients who had undergone stapedoplasty because of otosclerosis recently but with unsatisfactory functional outcome was carried out. Before the operation all patients underwent complete complex of clinical-audiological investigation.
Results. The causes of unsatisfactory results of stapedoplasty according to intraoperative findings data are the cicatricial changes in the posterior and superior sections of the tympanic cavity, in the region of the remote bone overhang of the back of the external auditory canal, tympanic membrane retraction and its fusion with the long leg of the incus in 12 patients (50%) patients. Dislocation of prosthesis, short prosthesis, not tight fixation of the prosthesis ring on a long stalk anvil, anvil dislocation occurred in 8 (33,4%) patients. Reossification foci in the oval window are detected in 4 (16,6%) patients.
Excellent and good functional results were achieved in 22 (91,6%) patients. In 2 (8,4%) operated patients hearing has not changed. After reoperation the closure of air-bone interval (ABI) was noted in all patients.
Conclusions. At reoperations because of poor functional results of stapedoplasty besides removing the leading pathogenetic factors responsible for the immobilization of the auditory ossicles, it is necessary to apply individual variants of surgical correction. They include the excision of the scar with the secondary partial reconstruction of the posterior wall of external auditory canal, malleostapedoplasty, reprostheses of the vestibular window, ossiculoplasty with autotissues or the implant.

Keywords: otosclerosis, stapedoplasty, unsatisfactory results, restapedoplasty, audiometry
p. 79 84 of the original issue
References

1.Preobrazhenskii NA, Patiakina OK. Stapedektomiia i stapedoplastika pri otoskleroze [Stapedectomy and stapedoplasty in otosclerosis]. Moscow, RF: Meditsina; 1973. 272 p.
2. Neuner N, Hausler R. Epidemiologic der otosklerose. ORL Nova. 2001; 11:12329.
3. Rosen S. Mobilization of the stapes to restore hearing in otosclerosis. St J Med (New York). 1953;11:2650 53.
4. Hildmann H, Sudhoff H. Middle ear surgery. Berlin, Germany: Springer-Verlag, New York: Heidelberg; 2006. 188 p.
5. Backous DD, Coker NJ, Jenkins HA. Prospective study of resident-performed stapedectomy. Am J Otol. 1993 Sep;14(5):45154.
6. Lesinski SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol. 2002 May;23(3):28188.
7. Martin Ch, Messary A, Bertholon P, Prades JM. Failure of regain full function after surgery for otosclerosis: causes, diagnosis and treatment. Rev Laryngol Otol Rhinol (Bord). 2003;124(1):2329. [Article in French]
8. Fisher EW, McManus TC. Surgery for external auditory canal exostoses and osteomata. J Laryngol Otol. 1994 Feb;108(2):10610.
9. Wiet RG, Harvey SA, Bauer GP. Complications in stapes surgery. Options for prevention and management. Otol Clin North Am. 1993 Jun;26(3):47190.
10. Ovchinnikov IuA, Kulakova LA. Rezul'taty khirurgicheskogo lecheniia bol'nykh kokhlearnoi formoi otoskleroza [Results of surgical treatment of patients with cochlear otosclerosis form]. In: Materialy Ros nauch-prakt konf otorinolaringol.. Orenburg, RF; 2002. p. 8090.
11. Aroesty JH, Lucente FE, Har-El G. Poststapedectomy incus necrosis. Otolaryngol Head Neck Surg. 1993 Dec;109(6):108384.
12. Ayache D, Lefeune D, Williams MT. Imaging of postoperative sensorineural complications of stapes surgery: a pictorial essay. Adv Otorhinolaryngol. 2007;65: 30813.
13. Salvinelli F, Casale M, Peco VD, Greco F, Trivelli M. Stapedoplasty in patients with small air-bone gap: why not? Med Hypotheses. 2003 Apr;60(4):53537.
14. Brahe Pedersen C, Felding JU. Stapes surgery: complications and airway infection C. Brahe Pedersen. Ann Otol Rhinol Laryngol. 1991 Aug;100(3):60711.
15. Shea JJ, Sanabria FS. Teflon piston operation for otosclerosis. Arch Otolaryng. 1962;76(5):51621.
16. Ramsay H, Karkkainen J, Palva T. Success in surgery for otosclerosis: hearing improvement and other indicators. Am J Otolaryngol. 1997 Jan-Feb;18(1):2328.
17. Dornhoffer J, Manning L. Unplanned admissions following outpatient otologic surgery: the University of Arkansas experience. Ear Nose Throat J. 2000 Sep; 79(9):710, 71317.

Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO Gomel'skii gosudarstvennyi meditsinskii universitet, kafedra otorinolaringologii s kursom oftal'mologii,
e-mail: drhossam64@mail.ru,
El'-Refai Khusam
Information about the authors:
Al-Refai Hossam, candidate of medical sciences, assistant professor of the chair of otorhinolaryngology with the course of ophthalmology of EE Gomel State
Medical University.
Sitnikov V.P., doctor of medical sciences, professor of the chair of otorhinolaryngology with the course of ophthalmology of EE Gomel State
Medical University.
Kolesnik T.I., a head of the otorhinolaryngology department of ME Gomel regional specialized clinical hospital.
Contacts | ©Vitebsk State Medical University, 2007