Modern surgical treatment of otosclerosis - Helda - Helsinki.fi

Introduction
complications, for example the use of a polyethylene tube prosthesis and gelatin foam as a
sealing material (Shambaugh and Glasscock 1980, Shea 1988, Hausler 2007). The
fenestration of the oval window had also evolved. Partial stapedectomy was suggested by
Plester to diminish inner ear irritation, and by the 1960s small-opening stapedotomy was
also introduced for the same reason (Shea 1988, Hausler 2007). Both techniques, total
removal of the footplate (stapedectomy) and small-opening stapedotomy, are still in use
and have proven successful in the long-term restoration of hearing (House et al. 2002,
Aarnisalo et al. 2003).
Unfortunately, stapes surgery has a risk of inner ear damage, leading to SNHL or balance
problems. Studies presented during the last decades have shown a significantly lower risk
of inner ear damage than earlier studies (Ludman and Grant 1973, Daniels et al. 2001,
Vincent et al. 2006). This could be due to technical advancements (laser, microscope,
instruments, prosthesis) in surgery, but the trend favouring stapedotomy may also have an
effect. Formerly, surgery was performed on only one of the patient’s ears. This was due to
the risk of SNHL which could occur even years after surgery (Ludman and Grant 1973,
Hammond 1976, Smyth et al. 1975). Nowadays, more surgeons are willing to operate on
both sides, probably because of the improved safety record of stapes surgery (Raut et al.
2002). Simultaneous bilateral surgery has not been reported in stapes surgery, even though
simultaneous surgery in ophthalmology has been performed for decades (Guo et al. 1990,
Beatty et al. 1995, Arshinoff et al. 2003, Sarikkola et al. 2004). Both types of surgeries
involve major sensory organs and, as such, have a similar profile of complications. If
bilateral complications were to occur for either sense, the result would be a major
deterioration in perception, the only difference being that in the case of blindness there are
markedly less opportunities for rehabilitation.
Although sensorineural hearing loss after surgery is unusual, vestibular symptoms after
surgery are very common. Fortunately, vestibular symptoms are usually mild and short
lasting (Aantaa and Virolainen 1978, Birch and Elbrond 1985, Wang et al. 2005). The
exact end organ affected is unknown. The number of studies focusing on vestibular
symptoms is limited, despite there being many studies on postoperative hearing. This is
probably because long-lasting symptoms are rare, and these symptoms have not been
shown to be related to hearing results (Aantaa and Virolainen 1978). Naturally, hearing
improvement has been the main interest of surgeons and patients. Today's trend towards
outpatient surgery has however, made studies concerning vestibular symptoms more
important. A patient with major postoperative vestibular symptoms cannot be treated as an
outpatient.
This thesis concentrates on three different areas of stapes surgery. First, the results of
simultaneous bilateral stapes surgery are presented and discussed. There is no current
literature addressing this issue. Second the applicability of stapes surgery in an outpatient
setting is evaluated, and differences between operative methods are compared. Third,
video-oculography (VOG) is used to investigate the cause of vestibular symptoms.
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