panel: endoscopic vs. microscopic- assisted stapedectomy€¦ · alejandro rivas, md associate...
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Panel: Endoscopic vs. Microscopic-Assisted Stapedectomy
Alejandro Rivas, MDAssociate Chief of Otology and Neurotology
Director of Endoscopic Ear SurgeryAssociate Professor
Dept. Otolaryngology-HNSVanderbilt University
The Otology Group of Vanderbilt
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Speaker DisclosureConsultant for:
- Med-el
- Advance Bionics
- Cochlear
- Grace Medical
- Stryker
- Cook Medical
.
The Otology Group of Vanderbilt
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Is it safe?
The Otology Group of Vanderbilt
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Do we have to remove scutum?
• Scutum anatomy
– 77.1%
• prevented placement with a straight alligator in of cases
• Chorda tympani
– Manipulated: 94.0%
The Otology Group of Vanderbilt
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Laser vs. Drilled Stapedotomy
Does it matter!!!
The Otology Group of Vanderbilt
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What about revision cases? Is there any difference?
The Otology Group of Vanderbilt
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CASE 1
• 45 year old female
• Diagnosed with otosclerosis at age 33 and had surgery at age 34.
• No hearing improvement.
• No dizziness. Pre-op
CT vs. no CT?
The Otology Group of Vanderbilt
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Tanya Lee, et al. CT grading system for otosclerosis. American journal of
neuroradiology 2009. DOI:10.3174/ajnr.A1558
The Otology Group of Vanderbilt
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CASE 1
The Otology Group of Vanderbilt
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CASE 1
Pre-op Post-op
The Otology Group of Vanderbilt
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CASE 2
Pre-op: 2015• 57-year-old male
• Dx. Bil Otosclerosis in 2013.
• Middle ear exploration:
– Unfavorable Anatomy
– Stapes very posterior
– facial dehiscence.
The Otology Group of Vanderbilt
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Dehiscent Facial Nerve?
The Otology Group of Vanderbilt
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Dehiscent Facial Nerve
The Otology Group of Vanderbilt
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Dehiscent Facial Nerve
Post-op 12m
The Otology Group of Vanderbilt
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Should we be doing stapes surgery in children?
The Otology Group of Vanderbilt
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Congenital Stapes Malformations
The Otology Group of Vanderbilt
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Congenital Stapes Malformations
The Otology Group of Vanderbilt
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Congenital Stapes Malformations
The Otology Group of Vanderbilt
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Should we be doing stapes surgery in Osteogenesis Imperfecta?
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CASE 4
The Otology Group of Vanderbilt
2016• 13-year-old girl
• Osteogenesis Imperfecta
• Blue sclera bilateral
• Bilateral CHL
• Wears HA for past 7 years
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CASE 4
The Otology Group of Vanderbilt
2016 2018
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The Otology Group of Vanderbilt
CASE 4
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CASE 4
Pre-op Post-op
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CASE 5
The Otology Group of Vanderbilt
2016• 45-year-old male
• Left-sided otosclerosis
• 2016: EES stapedotomy with a 4.5 mm prosthesis
• Hearing worsen in last 6 months
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CASE 5
The Otology Group of Vanderbilt
2016 2019
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The Otology Group of Vanderbilt
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CASE 6
The Otology Group of Vanderbilt
Pre-op• 63-year-old female
• 1990s: Bil Otosclerosis
• 1999: Stapes Sx
• Good hearing for 20 years.
• 2014: Left sudden hearing loss.
• 2014: Revision surgery, failed.
• 2015: 2nd Revision Surgery
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Incus Erosion and Perforation
The Otology Group of Vanderbilt
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Malleostapedotomy- Post-op
The Otology Group of Vanderbilt
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Revision Malleostapedotomy
The Otology Group of Vanderbilt
Pre-op Post-op
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Biscuit Footplate – can this be dealt with using one hand?
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FOOTPLATE FRACTURE
AUDIOMETRIC TESTWoman, 55 Years Old
Monolateral Air-Bone Gap
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FOOTPLATE FRACTURE
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F.U. 2 months - No tinnitus - No vertigo
AUDIOMETRIC TEST
FOOTPLATE FRACTURE
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Persistent
Stapedial
Artery?
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AUDIOMETRIC TEST
PERSISTENT STAPEDIAL ARTERY
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PERSISTENT STAPEDIAL ARTERY
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Conclusion
• Endoscopic stapes surgery is a safe and effective technique for managing otosclerosis
• The laser is the ideal instrument for endoscopic stapedotomy, but if not available, our results highlight the importance of doing an endoscopic stapedectomy
• Endoscopes provides paramount benefits in revision stapes cases, congenital stapes fixations and malformations.
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Questions