| The Long Prosthesis Syndrome
Primary Stapedectomy Diagramatic Part 1 Primary Stapedectomy Diagramatic Part 2 Stapedectomy Revision: Patient Selection |
Far Advanced Otosclerosis |
The Long Prosthesis Syndrome (13:44)
Disequilibrium, lack of concentration and memory loss. Return to index
Primary Stapedectomy Diagramatic Part 1 (16:42)
The technique of primary stapedectomy using a vein graft, and the self centering titanium Robinson Piston. The emphasis is on Intraoperative testing and the value of local anesthesia. Return to index
Primary Stapedectomy Diagramatic Part 2 (4:47) Return to index
Primary Stapedectomy Surgery (7:23)
Actual stapedectomy with the emphasis on technique, use of the speculum holder, a control hole and placement of the prosthesis. The laser must be used when indicated. Return to index
Stapedectomy Revision: Patient Selection (10:36)
Based on 2000 revision cases-do not revised in the 1st two months. Surgeon must be laser experienced. Best results obtained when after the previous surgery, the hearing went up and then down. Vibration means a short prosthesis. Return to index
Revision Stapedectomy (16:11)
A patient must have at least a 20 dB air bone gap and above 70% discrimination unless the less is severe. Do under local and use intraoperative testing. Check for malleus fixation. Return to index
The Tuning Fork (12:13)
Details of how to use the tuning fork- If the tuning forks and the audiogram disagree, it is usually the tuning fork that is correct. The Weber is more sensitive than the Rinne. Return to index
Juvenile Stapedectomy (3:30)
Most of these are done where the disease is bilateral. Expect a much larger percentage of obliterative otosclerosis requiring drill out. The results are almost as good as in adults. Return to index
Pregnancy and Otosclerosis (6:40)
We were all taught that the hearing is otosclerotic woman became worse with Pregnancy. This information was positively incorrect. Return to index
Revision of a Smart Prosthesis Surgery (4:00)
Made by Gyrus is easy to insert, but unfortunately has a memory and in relatively short periods of times it becomes nonfunctional in many cases. Return to index
Stapedectomy for the Elderly (2:34)
The elderly did just as well with stapedectomy as did the younger population. There was no higher incidence of vestibular symptoms. Return to index
Stapedectomy In Pilots (6:43)
Pilots who are in control of the aircraft may have a stapedectomy if a tissue graft is used. It is important to put them through a decompression chamber 3 months after surgery. Return to index
Stapedectomy in the 60’s through 90’s (4:51)
In the early days of stapedectomies there were many more cases of obliterative otosclerosis than we see now because now the patient has surgery earlier in the course of the disease. Return to index
Far Advanced Otosclerosis (4:16)
These are patients with no air measurements and no bone conduction preoperatively. Successful results were based on being able to use a hearing aid again, increase in discrimination and an increase in the hearing. Return to index
Facial Nerve (3:47)
As long as there is any access at all to the footplate, even by pushing the facial nerve aside, it is appropriate to do a stapedectomy. Return to index
Revision of Eroded Incus (10:28)
As long as there is even a small amount of the incus remaining a case can be revised using a modified Lippy prothesis. If the incus comes to a point it should be squared using a laser. Return to index
Stapedectomy vs. Stapedotomy (5:01)
We do not believe that stapedotomy is a superior procedure. The otologist should know how to do both procedures, utilizing a tissue graft if a stapedectomy is necessary. Return to index
Promontory Drilling (3:09)
This is absolute acceptable and non-harmful. It may be used when there is a promontory overhang or the incus is too long. Sweep up from the footplate and do the drilling in the posterior portion of the oval window area. Return to index
Intraoperative Audiometry (9:35)
This is imperative in our practice in revision stapedectomy. It is also wonderfully useful in primary stapedectomy in tympano-ossiculoplasty. Return to index
Floating Footplate (4:30)
In primary stapedectomy when the footplate inadvertently mobilizes and you do not have a hole in it, cover the footplate with a tissue graft and place the prosthesis. These cases are among our very best results. Return to index
B.A.H.A. (9:50)
Discussion of indications for BAHA implant. Patients with single sided deafness, mixed conductive nerve hearing loss and atresia are all candidates. Pre-operative evaluation is done with a test band to show the patients how they will hear with the implant. Return to index
Steps of the B.A.H.A. Surgery (3:37)
Technical discussion of BAHA implant with emphasis on proper surgical handling. Principles of skin graft, wound handling and tensionless closure are emphasized to minimize post-operative problems. Return to index
High Body Mass Index and skin overgrowth with the B.A.H.A.
A discussion of risk factors for skin overgrowth in BAHA surgery. In almost 100 patients the group that was more predisposed to scarring problems were the obese males. An elongated implant usually helps in these patients. Return to index
Total Ossiculoplasty (8:48) One of the more difficult middle ear reconstructions is total ossiculoplasty. This is due to not having a healthy middle ear bone to stabilize a prosthesis on, as in stapedectomy or partial ossiculplasty. In addition these patients usually have more chronic ear disease and many have had mastoidectomy performed. Two point stabilization assists in improving results in these difficult reconstructions. Return to index
Pre-Operative Instructions (10:38) Return to index
Surgery Under Local Anesthesia (16:25) Return to index