Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes?

Abstract

Purpose

The aims of this article are: (1) is there an ideal incudostapedial joint (ISJ) angle after stapedotomy? (2) is there any difference between pre- and postoperative ISJ angle? and (3) what is the significance of the ISJ angle in postoperative hearing outcomes?

Methods

Forty six ears from 39 different adult patients (28 women and 11 men; 21 left and 25 right ears) with a mean age of 39 years with clinical otosclerosis who underwent stapedotomy between May 2017 and May 2019 were retrospectively registered, including seven bilateral surgery cases. ISJ angle and intravestibular depth of the stapes prosthesis were measured from multiple planar reconstruction-computed tomography images and the length of the prosthesis was measured during surgery. Relationships between the ISJ angle parameters and postoperative hearing outcomes and parameters of the prosthesis were analyzed.

Results

The mean ISJ angle was 93.3° ± 8.8° preoperatively and 101.9° ± 6.3° postoperatively, increasing by 8.6° during stapedotomy (p < 0.01). There were weak and negative correlations between ISJ angle changes and postoperative air conduction gains at frequencies ≤1 kHz and bone conduction gains at 0.5 kHz. When the postoperative ISJ angle changed more than 20°, the success rate of the procedure decreased to 0%.

Conclusion

The stapedotomy operation increased the ISJ angle. The success of postoperative auditory outcomes had more to do with the ISJ angle change than the value of the angle itself, indicating there is no universal ideal ISJ angle that surgeons should aim for during stapedotomy.

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References

  1. 1.

    Zhang K, Fang Y, Wang B, Cheng X, Chen B, Shu Y (2020) Frequency-specific hearing results after stapes surgery for Chinese population otosclerosis with different degrees of hearing loss. Acta Otolaryngol 140(5):356–360

    Article  Google Scholar 

  2. 2.

    Mann WJ, Amedee RG, Fuerst G, Tabb HG (1996) Hearing loss as a complication of stapes surgery. Otolaryngol Head Neck Surg 115(4):324–328

    CAS  Article  Google Scholar 

  3. 3.

    Nakajima HH, Ravicz ME, Merchant SN, Peake WT, Rosowski JJ (2005) Experimental ossicular fixations and the middle ear's response to sound: evidence for a flexible ossicular chain. Hear Res 204(1–2):60–77

    Article  Google Scholar 

  4. 4.

    Cuny P, Alsolami NJ, Dobrev I, Warnholtz B, Röösli C, Sim JH (2019) Influence of angular positioning of the prosthesis in stapes surgeries with a NiTiBond prosthesis: investigation in cadaveric temporal bones. Hearing Res 378:149–156

    CAS  Article  Google Scholar 

  5. 5.

    Skinner M, Honrado C, Prasad M, Kent HN, Selesnick SH (2003) The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping. Laryngoscope 113(4):647–653

    Article  Google Scholar 

  6. 6.

    Alian W, Majdalawieh O, Kiefte M, Ejnell H, Bance M (2013) The effect of increased stiffness of the incudostapedial joint on the transmission of air-conducted sound by the human middle ear. Otol Neurotol 34(8):1503–1509

    Article  Google Scholar 

  7. 7.

    Szymanski M, Rusinek R, Zadrozniak M, Morshed K, Warminski J (2014) The influence of incudostapedial joint separation on the middle ear transfer function. Clin Exp Otorhinolar 7(4):250–253

    Article  Google Scholar 

  8. 8.

    Henrot P, Iochum S, Batch T, Coffinet L, Blum A, Roland J (2005) Current multiplanar imaging of the stapes. AM J Neuroradiol 26(8):2128

    PubMed  Google Scholar 

  9. 9.

    Panda N, Bakshi J, Verma R, Kaushal D, Gupta N (2014) Piston diameter in stapes surgery. Does it have a bearing? Indian J Otolog 20(1):33

    Article  Google Scholar 

  10. 10.

    Cavaliere M, Ricciardiello F, Mesolella M, Iengo M (2012) Stapedotomy: functional results with different diameter prostheses. ORL J Otorhinolaryngol Relat Spec 74(2):93–96

    CAS  Article  Google Scholar 

  11. 11.

    Laske RD, Roosli C, Chatzimichalis MV, Sim JH, Huber AM (2011) The influence of prosthesis diameter in stapes surgery: a meta-analysis and systematic review of the literature. Otol Neurotol 32(4):520–528

    Article  Google Scholar 

  12. 12.

    Wegner I, Eldaebes MM, Landry TG, Grolman W, Bance ML (2016) The effect of piston diameter in stapedotomy for otosclerosis: a temporal bone model. Otol Neurotol 37(10):1497–1502

    Article  Google Scholar 

  13. 13.

    Sudhoff H, Gehl HB, Boga E, Müller S, Wilms K, Mutze S, Todt I (2019) Stapes prosthesis length: one size fits all? Audiolog Neurotolog 24(1):1–7

    Article  Google Scholar 

  14. 14.

    Ali HI, Khater NH (2018) Otosclerosis and complications of stapedectomy: CT and MRI correlation. Alexandria J Med 54(3):197–201

    Article  Google Scholar 

  15. 15.

    Karhuketo TS, Lundmark J, Vanhatalo J, Rautiainen M, Sipilä M (2007) Stapes surgery: a 32-year follow-up. ORL J Otorhinolaryngol Relat Spec 69(5):322–326

    Article  Google Scholar 

  16. 16.

    Hornung JA, Brase C, Bozzato A, Zenk J, Iro H (2009) First experience with a new titanium clip stapes prosthesis and a comparison with the earlier model used in stapes surgery. The Laryngoscope 119(12):2421–2427

    Article  Google Scholar 

  17. 17.

    Lemmerling MM, Stambuk HE, Mancuso AA, Antonelli PJ, Kubilis PS (1997) Normal and opacified middle ears: CT appearance of the stapes and incudostapedial joint. Radiology 203(1):251–256

    CAS  Article  Google Scholar 

  18. 18.

    Singh A, Irugu DVK, Kumar R, Verma H, Gupta A, Kumari A (2020) Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization. J Otol 15:50–53

    Article  Google Scholar 

  19. 19.

    Sohoel T (1957) The course of bone conduction after fenestration operation. Acta Oto-Laryngol 47(5):462

    CAS  Article  Google Scholar 

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Funding

This work was supported by National Natural Science Foundation of China (No. 81822011, 81771013, 81700925, 81870726). No funding was received for this work from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), and other(s).

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Authors

Contributions

Yanqing Fang designed, analyzed data and wrote the paper; Kun Zhang collected and analyzed data from EENT hospital affiliated to Fudan University; and Liu-Jie redesigned, analyzed and reviewed the paper; JJ Lamb polished the paper and gave important suggestions; Rujian Hong guided how to collect MPR-CT data; Bing Chen designed the experiment, did all surgery in this study and reviewed the paper; Yilai Shu designed the experiment, reviewed and guided to write the paper. Yanqing Fang, Kun Zhang, and Liu-Jie Ren contributed equally to this work. All authors discussed the results and implications and commented on the manuscript at all stages.

Corresponding authors

Correspondence to Yilai Shu or Bing Chen.

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The authors of this manuscript declare no relationship with any company whose products or services may be related to the subject matter of the article.

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This article does not contain any studies with human participants or animals performed by any of the authors. This research was conducted in accordance with the ethical standards of the Internal Review Board of EENT Hospital affiliated with Fudan University. I, Bing Chen, as the corresponding author, ensure that there is no author identifying information anywhere in the blinded manuscript (i.e., author details, ethical statements, acknowledgements, author contribution, grant information, funding number, etc.).

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Fang, Y., Zhang, K., Ren, LJ. et al. Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes?. Eur Arch Otorhinolaryngol 278, 645–652 (2021). https://doi.org/10.1007/s00405-020-06103-7

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Keywords

  • Otosclerosis
  • Prosthesis
  • Stapedotomy
  • Incudostapedial joint (ISJ)
  • MPR-CT (multiple planar reconstruction-computed tomography)