Download PDF
Laryngorhinootologie 2018; 97(10): 717-734
DOI: 10.1055/a-0652-6494
Facharztwissen HNO
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und operative Therapie der Otosklerose

Teil II: Operative TherapieDiagnostics and Surgical Therapy of OtosclerosisPart 2: Indication, Surgical Procedure and Postoperative Treatment
Stefan K. Plontke
,
Marie-Luise Metasch
,
Jonas Zirkler
,
Thomas Zahnert
Further Information

Publication History

Publication Date:
19 October 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Für die – oft in Diagnostik und Therapie anspruchsvolle – Otosklerose kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden. Der erste Teil des Fortbildungsbeitrags umfasste Grundlagen, Diagnostik und Differenzialdiagnostik, im zweiten Teil soll auf therapeutische Aspekte und Nachsorge eingegangen werden.

Abstract

After approximately 100 years of development and stepwise improvement, stapes surgery is a succesful strategy of managing hearing loss in otosclerosis, although challanges remain. Contraindications include too poor speech understanding (not enough inner ear reserve), and acute or chronic inflammation of the external ear and middle ear. Stapes surgery in the last hearing ear can today be indicated in exceptional cases, especially if the contralateral ear was supplied with a cochlear implant. In case of simultaneous occurrence of pronounced external auditory canal exostoses, a staged procedure may be useful.

The surgical principle is to mechanically replace the fixed stapes with a piston-shaped implant under perforation or partial removal of the stapes footplate. Laser-assisted stapes surgery has proven itself in practice and the laser is used regularly today. In regard to revision surgery the increased risk of hearing loss or deafness and vertigo has to be considered. Revisions are made in the event of complications and persistent or newly occurring conductive components. In the case of insufficient hearing rehabilitation, alternative options should be considered, e. g. the combination of a stapes plastic with an active middle ear implant, or a cochlear implant.

Schlüsselwörter

Otosklerose - Stapesplastik - Stapedotomie - Laserstapedotomie

Key words

otosclerosis - stapes surgery - stapedotomy - laser stapedotomy
 

  • Literatur

  • 1 Albers AE, Wagner W, Stölzel K. et al. Laserstapedotomie. HNO 2011; 59: 1093-10102 doi:10.1007/s00106–011–2376-y
    CrossrefPubMedGoogle Scholar
  • 2 Arnold W, Ganzer U. Checkliste Hals-Nasen-Ohren-Heilkunde: 48 Tabellen. 5. Aufl.. Stuttgart: Thieme; 2011
    Google Scholar
  • 3 Bernardeschi D, De Seta D, Canu G. et al. Does the diameter of the stapes prosthesis really matter? A prospective clinical study. Laryngoscope. 2017 DOI: doi:10.1002/lary.27021
    CrossrefPubMedGoogle Scholar
  • 4 Danesh AA, Shahnaz N, Hall 3 rd JW. The Audiology of Otosclerosis. Otolaryngol Clin North Am 2018; 51: 327-342 doi:10.1016/j.otc.2017.11.007
    CrossrefPubMedGoogle Scholar
  • 5 de Oliveira Penido N, de Oliveira Vicente A. Medical Management of Otosclerosis. Otolaryngol Clin North Am 2018; 51: 441-452 doi:10.1016/j.otc.2017.11.006
    CrossrefPubMedGoogle Scholar
  • 6 Dhooge I, Desmedt S, Maly T. et al. Long-term hearing results of stapedotomy: analysis of factors affecting outcome. Eur Arch Otorhinolaryngol 2018; 275: 1111-1119 doi:10.1007/s00405–018–4899–2
    CrossrefPubMedGoogle Scholar
  • 7 Eshraghi AA, Ila K, Ocak E, Telischi FF. Advanced Otosclerosis: Stapes Surgery or Cochlear Implantation?. Otolaryngol Clin North Am 2018; 51: 429-440 doi:10.1016/j.otc.2017.11.012
    CrossrefPubMedGoogle Scholar
  • 8 Häusler R, Stieger C, Bernhard H. et al. A novel implantable hearing system with direct acoustic cochlear stimulation. Audiol Neurootol 2008; 13: 247-56 doi:10.1159/000115434
    CrossrefPubMedGoogle Scholar
  • 9 Harrill WC, Jenkins HA, Coker NJ. Barotrauma after Stapes Surgery: A Survey of Recommended Restrictions and Clinical Experiences. Am J Otol 1996; 17: 835-845 discussion 845–846
    PubMedGoogle Scholar
  • 10 Huber AM, Hornung J, Plontke S. et al. NiTiBOND, eine optimierte Steigbügelprothese zur chirurgischen Behandlung der Otosklerose. Laryngorhinootologie 2014; 93: 178-185 doi:10.1055/s-0033–1354378
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Hüttenbrink KB. Biomechanics of Stapesplasty: A Review. Otol Neurotol 2003; 24: 548-559
    CrossrefPubMedGoogle Scholar
  • 12 Hüttenbrink KB. Stapeschirurgie. In: HNO-Operationslehre. 5. Aufl.. Stuttgart: Thieme; 2018
    Google Scholar
  • 13 Hunter JB, Zuniga MG, Leite J. et al. Surgical and audiologic outcomes in endoscopic stapes surgery across 4 institutions. Otolaryngol Head Neck Surg 2016; 154: 1093-1098
    CrossrefPubMedGoogle Scholar
  • 14 Iacovidou A, Giblett N, Doshi J. et al. How reliable is the “scratch test” versus the Weber test after tympanomastoid surgery?. Otol Neurotol 2014; 35: 762-763 doi:10.1097/MAO.0000000000000357
    CrossrefPubMedGoogle Scholar
  • 15 Kabbara B, Gauche C, Calmels MN. et al. Decisive criteria between stapedotomy and cochlear implantation in patients with far advanced otosclerosis. Otol Neurotol 2015; 36: e73-78 doi:10.1097/MAO.0000000000000692
    CrossrefPubMedGoogle Scholar
  • 16 Kamalski DM, Verdaasdonk RM, de Boorder T. et al. Comparing mechanical effects and sound production of KTP, thulium, and CO2 laser in stapedotomy. Otol Neurotol 2014; 35: 1156-1162 doi:10.1097/MAO.0000000000000465
    CrossrefPubMedGoogle Scholar
  • 17 Klingmann C, Praetorius M, Böhm F. et al. Tauchtauglichkeit im HNO-Bereich. HNO 2008; 56: 509-518 doi:10.1007/s00106–008–1743–9
    PubMedGoogle Scholar
  • 18 Kösling S. Moderne Schläfenbeinbildgebung. HNO 2017; 65: 462-471
    CrossrefPubMedGoogle Scholar
  • 19 Lailach S, Schenke T, Baumann I. et al. Entwicklung und Validierung des Stapesplasty Outcome Test 25 (SPOT-25). HNO 2017; 65: 973-980 doi:10.1007/s00106–017–0389-x
    CrossrefPubMedGoogle Scholar
  • 20 Lailach S, Schenke T, Baumann I. et al. Living with otosclerosis: disease-specific health-related quality-of-life measurement in patients undergoing stapes surgery. Eur Arch Otorhinolaryngol 2018; 275: 71-79 doi:10.1007/s00405–017–4798-y
    CrossrefPubMedGoogle Scholar
  • 21 Laske RD, Röösli C, Chatzimichalis MV. et al. The influence of prosthesis diameter in stapes surgery: a meta-analysis and systematic review of the literature. Otol Neurotol 2011; 32: 520-528 doi:10.1097/MAO.0b013e318216795b
    CrossrefPubMedGoogle Scholar
  • 22 Lenarz T, Schwab B, Maier H. et al. Direct acoustic cochlear stimulation for therapy of severe to profound mixed hearing loss: Codacs™ Direct Acoustic Cochlear Implant System. HNO 2014; 62: 481-489 doi:10.1007/s00106–014–2893–6
    CrossrefPubMedGoogle Scholar
  • 23 McElveen Jr JT, Kutz Jr JW. Controversies in the Evaluation and Management of Otosclerosis. Otolaryngol Clin North Am 2018; 51: 487-499
    CrossrefPubMedGoogle Scholar
  • 24 Meltser I, Canlon B. Protecting the auditory system with glucocorticoids. Hear Res 2011; 281: 47-55 doi:10.1016/j.heares.2011.06.003
    CrossrefPubMedGoogle Scholar
  • 25 Metasch ML, Plontke SK, Zirkler J, Zahnert T. Diagnostik und operative Therapie der Otosklerose. Teil 1: Grundlagen, Diagnostik und Differenzialdiagnostik. Laryngorhinootol 2018; 97: 563-578 doi:10.1055/a-0589–3613
    PubMedGoogle Scholar
  • 26 Moscillo L, Imperiali M, Carra P. et al. Bone conduction variation post stapedotomy. Am J Otolaryngol 2006; 27: 330-333
    CrossrefPubMedGoogle Scholar
  • 27 Müller A, Mir-Salim P, Zellhuber N. et al. Influence of Floating-Mass Transducer Coupling Efficiency for Active Middle-Ear Implants on Speech Recognition. Otol Neurotol 2017; 38: 809-814 doi:10.1097/MAO.0000000000001412
    CrossrefPubMedGoogle Scholar
  • 28 Müller J, Plontke SK, Rahne T. Sprachaudiometrische Zielparameter in klinischen Studien zur Hörverbesserung. HNO 2017; 65: 211-218 doi:10.1007/s00106–016–0298–4
    CrossrefPubMedGoogle Scholar
  • 29 Nguyen Y, Bernardeschi D, Sterkers O. Potential of Robot-Based Surgery for Otosclerosis Surgery. Otolaryngol Clin North Am 2018; 51: 475-485 doi:10.1016/j.otc.2017.11.016
    CrossrefPubMedGoogle Scholar
  • 30 Preyer S. Endoskopische Ohrchirurgie – eine Weiterentwicklung der modernen Ohrchirurgie. HNO 2016; 64: 782-789
    CrossrefPubMedGoogle Scholar
  • 31 Quesada JL, Cammaroto G, Bonanno L. et al. Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena. Ear Nose Throat J 2017; 96: 302-310
    PubMedGoogle Scholar
  • 32 Quesnel AM, Ishai R, McKenna MJ. Otosclerosis: Temporal Bone Pathology. Otolaryngol Clin North Am 2018; 51: 291-303 doi:10.1016/j.otc.2017.11.001
    CrossrefPubMedGoogle Scholar
  • 33 Rahne T, Plontke SK. Apparative Therapie bei kombiniertem Hörverlust: Ein audiologischer Vergleich aktueller Hörsysteme. HNO 2016; 64: 91-100
    CrossrefPubMedGoogle Scholar
  • 34 Schick F. Alterations of bone conducted hearing in cases of modified middle ear mechanics. Conclusions from an electrical model. Eur Arch Otorhinolaryngol 1992; 249: 268-272
    CrossrefPubMedGoogle Scholar
  • 35 Schwager K. Akute Komplikationen in der Mittelohrchirurgie. Acute complications during middle ear surgery: Teil 2: Missgeschicke in der klassischen Stapeschirurgie und ihre Behebung. HNO 2007; 55: 411-416
    CrossrefPubMedGoogle Scholar
  • 36 Singh A, Datta R, Prasad BK. et al. Post Stapedotomy Vestibular Deficit: Is CO(2) Laser Better than Conventional Technique? A Non-randomized Controlled Trial. Indian J Otolaryngol Head Neck Surg 2018; 70: 306-312 doi:10.1007/s12070–018–1298–3
    CrossrefPubMedGoogle Scholar
  • 37 Tange RA. The history of otosclerosis treatment: a survey of more than a century’s search for the best treatment of the disease. Amsterdam: Kugler Publications; 2014
    Google Scholar
  • 38 Verschuur HP, de Wever WW, van Benthem PP. Antibiotic prophylaxis in clean and clean-contaminated ear surgery. Cochrane Database Syst Rev 2004; CD003996
    PubMedGoogle Scholar
  • 39 Vincent R, Wegner I, Vonck BDM. et al. Primary Stapedotomy in Children With Otosclerosis: A Prospective Study of 41 Consecutive Cases. Laryngoscope 2016; 126: 442-446
    CrossrefPubMedGoogle Scholar
  • 40 Wegner I, Kamalski DM, Tange RA. et al. Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review. Laryngoscope 2014; 124: 1687-1693 doi:10.1002/lary.24514
    CrossrefPubMedGoogle Scholar
  • 41 Wegner I, Verhagen JJ, Stegeman I. et al. A systematic review of the effect of piston diameter in stapes surgery for otosclerosis on hearing results. Laryngoscope 2016; 126: 182-190 doi:10.1002/lary.25408
    CrossrefPubMedGoogle Scholar
  • 42 Weir N, Mudry A. Otorhinolaryngology An Illustrated History. 2nd ed.. Ashford, UK: Headley Brothers Digital; 2013
    Google Scholar
  • 43 Yung MW, Oates J. The learning curve in stapes surgery and its implication for training. Adv Otorhinolaryngol 2007; 65: 361-369
    PubMedGoogle Scholar
  • 44 Zirkler J, Rahne T, Plontke SK. Stapeschirurgie bei Otosklerose mit einer neuen Titanprothese mit superelastischem Nitinol-Clip: Erste Erfahrungen. HNO 2016; 64: 111-116
    CrossrefPubMedGoogle Scholar