Modern surgical treatment of otosclerosis - Helda - Helsinki.fi

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Results and comments Table 4. The number and percentage of patients with different planes of pre- and postoperative nystagmus recorded while the eyes are covered. Percentage values are calculated from all patients recorded for that time period. HSN=head-shaking nystagmus. Nystagmus Spontaneous HSN Preoperative Horizontal 1 (9%) 0 Vertical 1 (9%) 0 Both 1 (9%) 0 One week postoperative Horizontal 4 (15%) 3 (11%) Vertical 1 (4%) 1 (4%) Both 1 (4%) 0 One month postoperative Horizontal 2 (7%) 3 (11%) Vertical 1 (4%) 0 Both 1 (4%) 0 3-4 months postoperative Horizontal 2 (11%) 1 (5%) Vertical 1 (5%) 1 (5%) Both 0 1 (5%) Short-term evaluation (IV) In this study, VOG was measured on average four hours (range 1.5-6 hours) after the operation. No nystagmus was found when fixation was allowed, and three patients (14%) had pathological nystagmus when the eyes were covered. Two patients had spontaneous horizontal nystagmus with an SPV of 1.9 º/s and 1.5 º/s. In both cases, the fast phase beated away from the operated ear, and with the latter patient there was also a minute torsional component. The third patient had vertical nystagmus with a maximum SPV of 2.2 º/s, and the fast phase beated upwards. The nystagmus was persistent when the other eye was covered. These patients did not complain of any postoperative vertigo or nausea. Seven patients had latent, spontaneous horizontal nystagmus that manifested during the lateral gaze in the direction of the fast phase only, with a gaze angle of less than 30 º. One patient had an upbeating component related to the horizontal nystagmus, and the remaining patients had primary horizontal nystagmus with an SPV between 1 and 3 º/s accompanied by a minor torsional component. The horizontal direction of nystagmus was excitatory in four patients, and inhibitory in three patients. The prevalence of latent, 54
Results and comments spontaneous horizontal nystagmus of 33% was significantly higher (p=0.0001) than in healthy controls. However, the occurrence of nystagmus did not correlate with vestibular symptoms (p=0.30). Eleven patients (52%) had vestibular symptoms after the operation. Four patients had rotatory vertigo, two vomited, three had a floating sensation, one had a tilting sensation and two suffered from unspecific dizziness. The vestibular symptoms were mild in seven, moderate in three, and not graded in one patient. Two of these patients stayed overnight in hospital. During the night following surgery, no medications were needed, and both patients were discharged from hospital the following day and had uneventful recoveries. At the time of VOG recordings, only one patient had a mild floating sensation; other patients were free of symptoms. Postoperative audiograms were performed 2-16 months after the operation. The postoperative AB-GAP was 8 dB (range 0-27 dB), and the mean postoperative PTA for AC was 30 dB (range 8-70 dB). No significant SNHL greater than 10 dB occurred and the average overclosure was 6 dB (range -5-25 dB). The audiological results of patients with vestibular symptoms did not differ significantly from those of the whole study group (p=0.85). The mean postoperative AB-GAP was 7 dB (range 0-16 dB) and overclosure was 8 dB (range 0-25 dB) in patients with vestibular symptoms. There were signs of semicircular canal disturbance presented as a latent, spontaneous horizontal-torsional nystagmus, but no specific nystagmus pattern was detected in patients with vestibular symptoms after the surgery. In conclusion, the origin of vestibular symptoms appears to be diverse. 55
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Department of Otorhinolaryngology U
Page 3 and 4: To my Family
Page 5 and 6: Stapedius tendon preservation 29 Re
Page 7 and 8: List of original publications The t
Page 9 and 10: Abstract Abstract The era of modern
Page 11 and 12: Tiivistelmä (Finnish summary) Tiiv
Page 13 and 14: 1 Introduction Introduction Otoscle
Page 15 and 16: 2 Review of the literature 2.1 Defi
Page 17 and 18: Clinical otosclerosis Review of the
Page 19 and 20: Review of the literature examinatio
Page 21 and 22: Review of the literature hearing lo
Page 23 and 24: Otosclerosis and Meniere’s diseas
Page 25 and 26: Review of the literature is positiv
Page 27 and 28: Review of the literature and light-
Page 29 and 30: Review of the literature shorter wa
Page 31 and 32: Review of the literature The analys
Page 33 and 34: Review of the literature Twenty-eig
Page 35 and 36: Review of the literature demonstrat
Page 37 and 38: Review of the literature disturb th
Page 39 and 40: Review of the literature images. In
Page 41 and 42: 3 Aims of the study Aims of the stu
Page 43 and 44: Studies III and IV Materials and me
Page 45 and 46: Materials and methods Study III inc
Page 47 and 48: Materials and methods Figure 2. Vis
Page 49 and 50: Results and comments improved signi
Page 51 and 52: Results and comments Table 3. Heari
Page 53: Results and comments A final follow
Page 57 and 58: Discussion The patient also would a
Page 59 and 60: Discussion surgeries are suitable f
Page 61 and 62: Discussion Patients with vestibular
Page 63 and 64: 7 Conclusions Conclusions Audiologi
Page 65 and 66: Acknowledgements Most of my writing
Page 67 and 68: References Baloh RW, Honrubia. Clin
Page 69 and 70: References Dahlqvist A, Diamant H,
Page 71 and 72: References Gersdorff M, Nouwen J, G
Page 73 and 74: References Jablokow VR, Kathuria S.
Page 75 and 76: References Markou K, Goudakos J. An
Page 77 and 78: References Perkings RC. Laser stape
Page 79 and 80: References Shabana YK, Ghonim MR, P
Page 81 and 82: References Toner JG, Smyth GDL. Com
Page 83 and 84: Appendix Questionnaire used to asse
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