The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Darius Kohan - One of the best experts on this subject based on the ideXlab platform.

  • the Malleus to oval window revision stapedotomy efficacy and longitudinal study outcome
    Laryngoscope, 2018
    Co-Authors: Peter A Benedict, Darius Kohan, Ling Zhou, Robert Peng
    Abstract:

    Objective To determine the longitudinal effectiveness of the Malleus to oval window stapedotomy technique among patients undergoing revision surgery when the incus is unavailable. Study Design Retrospective, case series. Methods Charts of 15 patients who underwent 17 Malleus attachment stapedotomies performed by a single surgeon from 2000 to 2015 were reviewed. Surgery was ambulatory, transcanal, with laser technique, and under local anesthesia. Results Of 17 stapedotomies performed, there were nine first revisions, six second revisions, one third revision, and one fourth revision. There were no surgical complications. Mean preoperative air-bone gap (ABG) was 32.3 dB. Mean postoperative ABG at 6 months was 10.7 dB, and at last follow-up was 16.3 dB. Average length of follow-up was 36.5 months. At last follow-up, 100% of first revisions achieved ABG ≤ 20 dB (77.8% ≤ 10 dB), compared to 50% of second revisions with ABG ≤ 20 dB (none ≤ 10 dB), and 0% of third or fourth revisions with ABG ≤ 20 dB. Trend lines for second and third/fourth revisions showed a deterioration (widening) in postoperative ABG by 0.18 and 0.72 dB per month, respectively. The first-revision trend line, conversely, showed negligible change with time, demonstrating the superior durability of first revisions compared to subsequent surgeries. Conclusion The Malleus to oval window stapedotomy technique is more effective and longer lasting in first-revision surgery compared to subsequent procedures. Standard or implantable amplification devices may be preferable for patients with multiple prior procedures. Level of Evidence 4. Laryngoscope, 2017

  • Revision stapes surgery: the Malleus to oval window wire-piston technique.
    The Laryngoscope, 2003
    Co-Authors: Darius Kohan, Alexander Sorin
    Abstract:

    Objective To determine the effectiveness of the Malleus to oval window wire-piston revision stapes surgery technique. Study Design A retrospective analysis of 243 stapes procedures performed by the senior author over a 10-year period identified 15 revisions. Five patients underwent a Malleus to oval window wire-piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted. Methods Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire-piston prosthesis. Results Among revision stapes procedures, there was no significant difference in the air-bone gap closure or complication rate between the incus to oval window and the Malleus to oval window techniques. The average preoperative air-bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss. Conclusions In experienced hands, revision stapes surgery using the Malleus to oval window stapes wire-piston prosthesis is safe and effective.

Saumil N. Merchant - One of the best experts on this subject based on the ideXlab platform.

  • Isolated fracture of the manubrium of the Malleus.
    Journal of Laryngology and Otology, 2007
    Co-Authors: Wade W Chien, Michael J. Mckenna, John J. Rosowski, Saumil N. Merchant
    Abstract:

    Objective To describe a series of five patients with isolated fracture of the manubrium of the Malleus.

  • results after revision stapedectomy with Malleus grip prosthesis
    Annals of Otology Rhinology and Laryngology, 2006
    Co-Authors: Sarp Sarac, Michael J. Mckenna, Joseph B Nadol, Anthony A Mikulec, Steven D Rauch, Saumil N. Merchant
    Abstract:

    Revision stapedectomy with a Malleus grip prosthesis is a technically challenging otologic procedure. The prosthesis is usually longer and extends deeper into the vestibule than a conventional stapes prosthesis, creating the potential to affect the vestibular sense organs. The prosthesis also bypasses the ossicular joints, which are thought to play a role in protecting the inner ear from large changes in static pressure within the middle ear. The prosthesis is in close proximity to the tympanic membrane, thus increasing the risk for its extrusion. We reviewed our experience with revision stapedectomy with the Schuknecht Teflon-wire Malleus grip prosthesis in 36 ears with a mean follow-up of 23 months. The air-bone gap was closed to within 10 dB in 16 ears (44%) and to within 20 dB in 26 ears (72%). The incidence of postoperative sensorineural hearing loss was 8% (3 ears). There were no dead ears. Extrusion of the prosthesis occurred in 1 case (3%). Nearly 50% of patients reported various degrees of vertigo or disequilibrium during the first 3 weeks after surgery. These vestibular symptoms resolved by 6 weeks in all but 1 case. We did not find evidence of damage to the inner ear due to the length of the prosthesis or due to the potential for direct transmission of changes in static pressures within the middle ear to the labyrinth. Our results are similar to those published in the literature for Malleus attachment stapedectomy and conventional revision incus stapedectomy.

  • experimental and clinical studies of Malleus fixation
    Laryngoscope, 2005
    Co-Authors: Hideko Heidi Nakajima, John J. Rosowski, Saumil N. Merchant, Michael E Ravicz, William T Peake
    Abstract:

    Objectives/Hypothesis: Preoperative clinical diagnosis of Malleus fixation can be difficult. “Fixation” of the Malleus can be caused by various disorders or diseases: fibrous tissue, bony spurs, and neo-osteogenesis around the Malleus head or stiffening of the anterior malleal ligament. The conductive hearing loss produced by these disorders or diseases has not been well characterized. The study goals were 1) to determine the effects of various types of Malleus fixation using a cadaveric temporal bone preparation and 2) to assess the clinical utility of umbo velocity measurements in preoperative differential diagnosis of Malleus fixation and stapes fixation. Methods: Umbo and stapes velocity were measured in 18 fresh cadaveric human temporal bones with laser vibrometry before and after controlled application of adhesives to the Malleus, stapes, or both ossicles. Results: Each simulated pathological condition produced a specific degree of loss in stapes velocity: stiffening of anterior malleal ligament, 0 to 8 dB; fibrous tissue around Malleus head, less than 10 dB; bony bar to Malleus head, 10 to 30 dB; and extensive neo-osteogenesis around Malleus head, greater than 35 dB. Simulated Malleus fixations generally produced similar reductions in both umbo and stapes velocity. Stapes fixation reduced stapes velocity with little change in umbo velocity. Because the change in stapes velocity would be similar to conductive hearing loss, experimental results were directly compared with clinical measurements of umbo velocity in surgically confirmed cases of Malleus or stapes fixation. The effects of Malleus and stapes fixations between the clinical and experimental data were similar. Conclusion: The study showed that measurements of umbo velocity and air-bone gap can enable one to diagnose Malleus fixation and specifies how to differentiate Malleus from stapes fixation.

Alexander Sorin - One of the best experts on this subject based on the ideXlab platform.

  • Revision stapes surgery: the Malleus to oval window wire-piston technique.
    The Laryngoscope, 2003
    Co-Authors: Darius Kohan, Alexander Sorin
    Abstract:

    Objective To determine the effectiveness of the Malleus to oval window wire-piston revision stapes surgery technique. Study Design A retrospective analysis of 243 stapes procedures performed by the senior author over a 10-year period identified 15 revisions. Five patients underwent a Malleus to oval window wire-piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted. Methods Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire-piston prosthesis. Results Among revision stapes procedures, there was no significant difference in the air-bone gap closure or complication rate between the incus to oval window and the Malleus to oval window techniques. The average preoperative air-bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss. Conclusions In experienced hands, revision stapes surgery using the Malleus to oval window stapes wire-piston prosthesis is safe and effective.

Richard L. Goode - One of the best experts on this subject based on the ideXlab platform.

  • Effect of absence of Malleus on ossiculoplasty in human temporal bones
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
    Co-Authors: Yoshitaka Shimizu, Richard L. Goode
    Abstract:

    OBJECTIVE: We evaluated the effect of Malleus presence or absence on middle ear sound transmission after middle ear reconstruction in a temporal bone model.STUDY DESIGN: Human cadaveric temporal bone study.METHODS: The velocity of the stapes footplate was measured using a laser Doppler vibrometer. After baseline measurements in eight intact temporal bones, reconstructed middle ear transmission with and without the Malleus was analyzed. Furthermore, to assess the influence of interposed cartilage, cartilage pieces of three different diameters were inserted and the three test conditions compared.RESULTS: Reconstruction without a Malleus tended to be slightly worse at 0.6 to 3.0 kHz. However, these differences were not statistically significant. In the cartilage experiments, the large-diameter cartilage was the worst at 0.25 kHz and 0.5 kHz but was better than the medium-diameter cartilages at 3.0 kHz and 4.0 kHz (P < 0.05).CONCLUSION: Absence of the Malleus impaired middle ear sound transmission slightly in...

  • Acoustic Effect of Malleus Head Removal and Tensor Tympani Muscle Section on Middle Ear Reconstruction
    The Laryngoscope, 1997
    Co-Authors: Masanori Asai, Joseph B. Roberson, Richard L. Goode
    Abstract:

    In the reconstruction of ears with a missing incus, an incus replacement prosthesis (IRP) is commonly used to connect Malleus and stapes. In some cases, it is necessary to resect the Malleus head and/or section the tensor tympani muscle (TTM) tendon. The acoustic effects of these maneuvers have not been well studied. We performed experiments in a temporal bone model to measure the effect of these maneuvers on middle ear sound transmission. Measurements of umbo and stapes displacement were made before and after Malleus head removal and TTM section plus incus replacement with an IRP. After Malleus head removal, there was a peak gain in stapes displacement of 6 dB below 0.5 kHz and 8 dB above 2.5 kHz. TTM section had a similar but lesser effect. A clinical example is described.

Kristian Bakpedersen - One of the best experts on this subject based on the ideXlab platform.

  • underlay tympanoplasty with the graft lateral to the Malleus handle
    Clinical Otolaryngology, 1992
    Co-Authors: Jan Stage, Kristian Bakpedersen
    Abstract:

    In conventional underlay tympanoplasty the graft is placed medial to the Malleus handle. The present study evaluates the results of a modification of this technique, in which the graft is placed lateral to the Malleus handle, which has been dissected from the drum remnants. 39 ears with predominantly large or anterior pars tensa perforations were operated upon in this manner. After a median observation time of 20 months one ear was found to have a small reperforation. All ears had normal tympanomeatal angles, but 12 ears showed a small degree of laterofixation of the graft from the Malleus handle. Analysis of the hearing showed good hearing improvement and no adverse effects attributable to the dissection of the ossicular chain. It is concluded that the technique is a good alternative to conventional underlay myringoplasty in ears with perforations involving the area anterior to the Malleus handle.